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Research article
Can Axillary Surgery Be Omitted in Patients With Breast Pathologic Complete Response After Neoadjuvant Systemic Therapy for Breast Cancer? A Real-World Re Trospective Study in China
Xiaoming Zha
Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2604-811X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 (no residual invasive or in situ carcinoma in the breast) and ypTis (in situ carcinoma in the breast) subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown.
Methods
This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR.
Results
Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (P = 0.0034).
Conclusion
Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).
Keywords
breast cancer, neoadjuvant systemic therapy, pathologic complete response, axillary surgery
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This preprint is under consideration at Breast Cancer Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Can Axillary Surgery Be Omitted in Patients With Breast Pathologic Complete Response After Neoadjuvant Systemic Therapy for Breast Cancer? A Real-World Re Trospective Study in China
Xiaoming Zha
Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2604-811X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 13 Jan, 2021
No community comments so far
First submitted
On 05 Jan, 2021
Editor assigned
On 05 Jan, 2021
Submission checks complete
On 05 Jan, 2021
Editor invited
On 05 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cancer Biology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 (no residual invasive or in situ carcinoma in the breast) and ypTis (in situ carcinoma in the breast) subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown.
Methods
This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR.
Results
Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (P = 0.0034).
Conclusion
Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).