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Background <p>The management of breast cancer has evolved significantly toward multimodality therapy and surgical de-escalation. However, most of the evidence supporting these strategies originates from western populations, which differ biologically and demographically from the Indian population. This study aimed to analyse trends in pathological complete response (pCR) and axillary pathological complete response (apCR) to assess the feasibility of axillary surgical de-escalation in the Indian context.</p> Methods <p>A single-centre retrospective analysis of a prospectively maintained database was conducted on 410 patients who received neoadjuvant chemotherapy (NACT) followed by surgery. Clinicopathological variables, including age, clinical stage, and molecular classification, were analyzed using univariate and multivariate logistic regression to identify factors associated with pathological complete response (pCR).</p> Results <p>The median age of the cohort was 47 years, with most patients presenting with locally advanced breast cancer 63.8% (262/410) and clinical nodal involvement 81.2% (333/410). The overall pathological complete response(pCR) (combined breast and axilla) rate was 45.9% (188/410); while axillary pCR (ypN0) was achieved in 71.2% (292/410) of patients. Notably, among patients who were clinically node-positive at baseline, the true axillary conversion rate to ypN0 was 67.0% (223/333). HER2-enriched and triple-negative Breast Cancer (TNBC) subtypes demonstrated the highest response rates. On multivariate analysis, higher clinical nodal stage (cN2/cN3) and hormone receptor positivity were identified as independent predictors of reduced axillary response. In contrast, HER2-targeted therapy was significantly associated with higher odds of nodal clearance. A strong association was observed between breast pCR and axillary pCR (OR 9.23; <i>p</i> &lt; 0.001).</p> Conclusion <p>This study demonstrates a high rate of axillary sterilization 71.2% (292/410) following neoadjuvant chemotherapy (NACT), suggesting that de-escalation of axillary surgery may be a feasible strategy. However, local validation and prospective studies are required before its routine adoption in clinical practice.</p>

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Axillary Response to Neoadjuvant Chemotherapy: Expanding the Scope for Conservative Surgical Management

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Vasireddy Sadasivudu,
  • Venkatesh Shrinivas,
  • Arul Kumar,
  • Harsh Karun,
  • Gunjan Hind,
  • Mayank Tripathi

摘要

Background

The management of breast cancer has evolved significantly toward multimodality therapy and surgical de-escalation. However, most of the evidence supporting these strategies originates from western populations, which differ biologically and demographically from the Indian population. This study aimed to analyse trends in pathological complete response (pCR) and axillary pathological complete response (apCR) to assess the feasibility of axillary surgical de-escalation in the Indian context.

Methods

A single-centre retrospective analysis of a prospectively maintained database was conducted on 410 patients who received neoadjuvant chemotherapy (NACT) followed by surgery. Clinicopathological variables, including age, clinical stage, and molecular classification, were analyzed using univariate and multivariate logistic regression to identify factors associated with pathological complete response (pCR).

Results

The median age of the cohort was 47 years, with most patients presenting with locally advanced breast cancer 63.8% (262/410) and clinical nodal involvement 81.2% (333/410). The overall pathological complete response(pCR) (combined breast and axilla) rate was 45.9% (188/410); while axillary pCR (ypN0) was achieved in 71.2% (292/410) of patients. Notably, among patients who were clinically node-positive at baseline, the true axillary conversion rate to ypN0 was 67.0% (223/333). HER2-enriched and triple-negative Breast Cancer (TNBC) subtypes demonstrated the highest response rates. On multivariate analysis, higher clinical nodal stage (cN2/cN3) and hormone receptor positivity were identified as independent predictors of reduced axillary response. In contrast, HER2-targeted therapy was significantly associated with higher odds of nodal clearance. A strong association was observed between breast pCR and axillary pCR (OR 9.23; p < 0.001).

Conclusion

This study demonstrates a high rate of axillary sterilization 71.2% (292/410) following neoadjuvant chemotherapy (NACT), suggesting that de-escalation of axillary surgery may be a feasible strategy. However, local validation and prospective studies are required before its routine adoption in clinical practice.