Wang Yuying, Wang Rui, Lu Di, Zeng Yaling, Tu Xihui, Liu Shiwei, Zhang Purong
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
College of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, 637000, China.
BMC Cancer. 2025 Jan 27;25(1):156. doi: 10.1186/s12885-025-13571-9.
This study explores the predictive factors for axillary pathological complete response(apCR) during neoadjuvant therapy(NAT) for elderly breast cancer patients to supplement the indications for retaining the axilla.
Comprehensive clinical information was gathered from November 2016 to July 2023 from elderly patients with pathology-confirmed invasive breast cancer who underwent NAT and surgery in the Breast Department of Sichuan Cancer Hospital. The relationships between clinicopathological characteristics and apCR were investigated via retrospective analysis. Univariate analysis of the clinicopathological parameters and efficacy was performed via the chi-square test or Fisher's exact test, while multivariate analysis was conducted via binary logistic regression.
This study included 109 elderly patients with breast cancer, with an overall apCR rate of 46.8%. The univariate analysis results showed that the initial clinical lymph nodes negative(cN0) stage, Human Epidermal Growth Factor Receptor 2(HER2) positivity and breast pathological complete response(bpCR) were significantly correlated with high apCR rates(all P < 0.05). Multivariate analysis revealed that apCR exhibited a significant association with initial cN0 stage and HER2 positivity. The apCR rate for HER2-positive elderly patients with initial cN0 disease is 100.0%,whereas the lowest apCR rate is observed in HER2-negative and clinical lymph nodes positive(cN+) patients(36.0%). Subgroup analysis revealed a close relationship between molecular subtypes and apCR.
This study indicates that initial cN0 stage and HER2 positivity can serve as independent predictive factors for apCR after NAT in elderly breast cancer patients. HER2-positive elderly patients with initial cN0 stage can be considered exempt from axillary lymph node dissection(ALND) after standard NAT.
本研究探讨老年乳腺癌患者新辅助治疗（NAT）期间腋窝病理完全缓解（apCR）的预测因素，以补充保留腋窝的指征。
收集2016年11月至2023年7月在四川省肿瘤医院乳腺科接受NAT和手术的老年病理确诊浸润性乳腺癌患者的综合临床信息。通过回顾性分析研究临床病理特征与apCR之间的关系。采用卡方检验或Fisher精确检验对临床病理参数与疗效进行单因素分析，采用二元逻辑回归进行多因素分析。
本研究纳入109例老年乳腺癌患者，总体apCR率为46.8%。单因素分析结果显示，初始临床淋巴结阴性（cN0）分期、人表皮生长因子受体2（HER2）阳性和乳腺病理完全缓解（bpCR）与高apCR率显著相关（均P<0.05）。多因素分析显示，apCR与初始cN0分期和HER2阳性显著相关。初始cN0疾病的HER2阳性老年患者的apCR率为100.0%，而HER2阴性且临床淋巴结阳性（cN+）患者的apCR率最低（36.0%）。亚组分析显示分子亚型与apCR之间存在密切关系。
本研究表明，初始cN0分期和HER2阳性可作为老年乳腺癌患者NAT后apCR的独立预测因素。初始cN0分期的HER2阳性老年患者在标准NAT后可考虑免于腋窝淋巴结清扫（ALND）。
