Optimizing Axillary Management in Triple-Negative Breast Cancer Following Neoadjuvant Chemotherapy.

INTRODUCTION

Triple-negative breast cancer (TNBC) often shows significant response to neoadjuvant chemotherapy (NACT), creating opportunities for axillary de-escalation. This study investigates axillary de-escalation and the factors influencing its use in TNBC.

METHODS

Patients with cT1-cT2, cN1 TNBC treated between 2012 and 2020 were identified from the National Cancer Database. Nodal response rates, including achievement of ypN0, were analyzed. Logistic regression identified clinical and sociodemographic factors associated with axillary management.

RESULTS

Among 12,742 patients undergoing axillary lymph node dissection (ALND), 31.7% achieved nodal pathologic complete response (pCR). These patients were more also likely to achieve breast tumor pCR. Treatment across multiple facilities was associated with a higher likelihood of attempted axillary de-escalation. ALND rates steadily declined between 2014 and 2020.

CONCLUSION

Despite achieving nodal pCR after NACT, many patients with TNBC underwent ALND. These findings underscore the need to refine criteria and increase adoption of axillary de-escalation strategies in TNBC.