Mitri Samir, Manfroi Laura Martin, Pannu Prabh R, Means Jessica, Roldan-Vasquez Estefania, Borgonovo Giulia, Hamid Tarbia, Thakkar Hiral, Davis Roger B, James Ted A
Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA.
Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA.
Clin Breast Cancer. 2025 Aug;25(6):521-528.e1. doi: 10.1016/j.clbc.2025.03.020. Epub 2025 Mar 31.
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.
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.
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.
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.
三阴性乳腺癌（TNBC）对新辅助化疗（NACT）往往有显著反应，为腋窝治疗降阶梯创造了机会。本研究调查了TNBC腋窝治疗降阶梯情况及其影响因素。
从国家癌症数据库中识别出2012年至2020年间接受治疗的cT1 - cT2、cN1 TNBC患者。分析了淋巴结反应率，包括达到ypN0的情况。逻辑回归确定了与腋窝处理相关的临床和社会人口统计学因素。
在12742例行腋窝淋巴结清扫术（ALND）的患者中，31.7%达到淋巴结病理完全缓解（pCR）。这些患者也更有可能实现乳腺肿瘤pCR。在多个机构接受治疗与尝试腋窝治疗降阶梯的可能性更高相关。2014年至2020年间，ALND率稳步下降。
尽管NACT后达到了淋巴结pCR，但许多TNBC患者仍接受了ALND。这些发现强调了在TNBC中完善标准并增加腋窝治疗降阶梯策略应用的必要性。
