Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Universidad de Navarra, Madrid, Spain.
Department of Breast Surgical Oncology, Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
J Surg Oncol. 2021 Jan;123(1):71-79. doi: 10.1002/jso.26236. Epub 2020 Oct 1.
Breast conservative surgery (BCS) and sentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is safe and effective for selected patients. This aim of this study is to evaluate the impact of anatomic site of response on outcomes and to assess the real population who may benefit from nonsurgical approaches after NAT.
From a prospectively maintained database, patients with T1-4 N0-2 breast cancer undergoing NAT were identified. Clinicopathological and survival rates were compared in relation to response and anatomic site of response.
Six hundred and forty-six patients were included in the study. Pathologic complete response (pCR) was an independent factor for BCS and SLN. HER2 positive and TN tumors with cN0 achieving a breast pCR remain ypN0 (p = .002). Residual axillary disease was associated with breast residual tumor (p = .05) and subtype (p = .001). With a median follow up of 35.25 months, patients with any pCR had improved survival when compared with partial response, but not significant differences between pCR, axillary pCR, or breast pCR.
Achieving a pCR increases BCS and SLN. In selected subgroups, sparing any axillary surgery after NAT maybe feasible. In cN+ patients, any pCR was associated with survival, but not the anatomic site of response.
新辅助治疗（NAT）后保乳手术（BCS）和前哨淋巴结活检（SLNB）对于选定的患者是安全有效的。本研究的目的是评估反应的解剖部位对结局的影响，并评估可能从 NAT 后非手术方法中获益的真实人群。
从一个前瞻性维护的数据库中，确定了接受 NAT 的 T1-4 N0-2 期乳腺癌患者。根据反应和反应的解剖部位比较了临床病理和生存率。
研究共纳入 646 例患者。病理完全缓解（pCR）是 BCS 和 SLN 的独立因素。HER2 阳性和 TN 肿瘤且 cN0 达到乳腺 pCR 仍为 ypN0（p = .002）。残留腋窝疾病与残留乳腺肿瘤（p = .05）和亚型（p = .001）相关。中位随访 35.25 个月后，与部分缓解相比，任何 pCR 患者的生存均得到改善，但 pCR、腋窝 pCR 或乳腺 pCR 之间无显著差异。
达到 pCR 可增加 BCS 和 SLN。在选定的亚组中，NAT 后可能可行保留任何腋窝手术。在 cN+患者中，任何 pCR 均与生存相关，但与反应的解剖部位无关。
