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Relationship Between Breast and Axillary Pathologic Complete Response in Women Receiving Neoadjuvant Chemotherapy for Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

We aim to delineate the relationship between breast and axillary pathologic complete response (pCR) in patients receiving neoadjuvant chemotherapy for breast cancer.

Methods

We performed a retrospective cohort study of patients with clinical T1–4N0–3M0 breast cancer receiving neoadjuvant chemotherapy followed by surgical therapy at Sunnybrook Health Sciences Centre in Toronto, Canada between 2014 and 2019. Clinicopathologic data were abstracted from the electronic medical record. Women were stratified into receptor subtypes as follows: hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2–), HR+/HER2+, HR–/HER2+ and HR–/HER2– (triple negative) and compared with Fisher’s exact test. Our primary outcome was to assess the positive predictive value of breast pCR for determining axillary pCR, and vice versa.

Results

There were 374 breast cancers, with 109 (29.1%) achieving breast pCR (ypT0/Tis). Amongst node-positive tumours achieving breast pCR, rates of associated axillary pCR (ypN0/0i+) were as follows: HR+/HER2– (2/6, 33.3%), HR+/HER2+ (12/13, 92.3%), HR–/HER2+ (15/17, 88.2%) and triple negative (15/17, 88.2%) (P = 0.02). Conversely, amongst node-positive tumours achieving axillary pCR, rates of associated breast pCR were: HR+/HER2– (2/10, 20.0%), HR+/HER2+ (12/23, 52.2%), HR–/HER2+ (15/24, 62.5%) and triple negative (15/26, 57.7%) (P = 0.1).

Conclusions

Breast pCR is a strong predictor of axillary pCR in women with HER2-positive and triple-negative breast cancers. Conversely, axillary pCR is a modest predictor of breast pCR for these subtypes. There is a poor relationship between breast and axillary pCR in women with hormone receptor-positive disease. These data may inform future de-escalation of surgery in women with HER2-positive and triple-negative disease.

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Acknowledgements

D.W.L. is supported by the Canadian Institutes of Health Research (CIHR) Fellowship from 2019 to 2022. He is also supported by the Helen Marion Walker-Soroptimist Women’s Health Research Scholarship and the Canadian Cancer Society Chair in Breast Cancer Research at Women’s College Research Institute (Women’s College Hospital, Toronto, Ontario, Canada).

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Authors and Affiliations

  1. Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    David W. Lim MDCM, MEd, PhD

  2. Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada

    David W. Lim MDCM, MEd, PhD

  3. Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada

    David W. Lim MDCM, MEd, PhD

  4. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Brittany D. Greene MD & Nicole J. Look Hong MD, MSc

  5. Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada

    Nicole J. Look Hong MD, MSc

  6. Division of Surgical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada

    Nicole J. Look Hong MD, MSc

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  1. David W. Lim MDCM, MEd, PhD
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Correspondence to David W. Lim MDCM, MEd, PhD.

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Disclosure

D.W.L. and B.D.G. have no conflicts of inflicts. N.J.L.H. is a consultant for MOLLI Surgical.

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This work was presented as a Quickshot oral presentation on 1 May 2021 at the 22nd Annual Meeting of the American Society of Breast Surgeons (ASBrS) and received the 2021 ASBrS Scientific Impact Recognition Award for best presentation as voted on by the audience at the ASBrS Annual Meeting.

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Lim, D.W., Greene, B.D. & Look Hong, N.J. Relationship Between Breast and Axillary Pathologic Complete Response in Women Receiving Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 28, 5495–5506 (2021). https://doi.org/10.1245/s10434-021-10519-8

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