Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Axillary Surgery and Pathological Assessment
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Axillary Surgical Approaches and Nodal Staging Post-Neoadjuvant Therapy
3.3. Predictors of Residual High-Burden Axillary Disease
3.4. Predictive Performance of the Model
4. Discussion
4.1. Main Predictors of Residual High-Burden Disease and Comparative Evidence from Predictive Models and Nomograms
4.2. Validation of the Predictive Role of HR+/HER2− Tumors
4.3. The Role and Limitations of Axillary Lymph Node Dissection
4.4. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Number (%)/Mean (SD) |
---|---|
Demographics | |
Age (years) | 53.1 (11.9) |
Post-menopausal | 158 (60.3%) |
Pre-operative staging | |
Mammography | 180 (68.7%) |
Breast and axillary US | 262 (100%) |
Axillary biopsy | 102 (38.9%) |
MRI | 105 (40.1%) |
PET | 189 (72.1%) |
Dimension pre-NAT (mm) | 36.3 (17.8) |
Stage pre-NAT | |
cT1 | 39 (14.9%) |
cT2 | 152 (58.0%) |
cT3 | 36 (13.7%) |
cT4 | 35 (13.4%) |
cN0 | 21 (8.0%) |
cN+ | 241 (92.0%) |
Neoadjuvant therapy | |
NAT without anthracycline | 12 (4.6%) |
NAT with anthracycline and taxanes | 250 (95.4%) |
Trastuzumab | 84 (32.1%) |
Pertuzumab | 6 (2.3%) |
Pembrolizumab | 8 (3.0%) |
Completed cycles | 227 (86.6%) |
Tumor | |
Subtype | |
HR+/HER2− | 120 (45.8%) |
HER2+ | 84 (32.1%) |
Triple-negative | 58 (22.1%) |
Histotype | |
Ductal | 239 (91.2%) |
Lobular | 23 (8.8%) |
Single nodule | 190 (72.5%) |
Pathologic response | |
Dimension post-NAT (mm) | 19.0 (25.5) |
Stage post-NAT | |
ypT0 | 54 (20.6%) |
ypTis | 13 (5.0%) |
ypTmi | 4 (1.5%) |
ypT1a | 18 (6.9%) |
ypT1b | 22 (8.4%) |
ypT1c | 60 (22.9%) |
ypT2 | 65 (24.8%) |
ypT3 | 4 (1.5%) |
ypT4 | 22 (8.4%) |
Surgical treatment | |
BCS | 111 (42.4%) |
Mastectomy | 151 (57.6%) |
Post-operative treatment | |
Taxanes | 21 (8.0%) |
Capecitabine | 28 (10.7%) |
Radiotherapy | 223 (85.1%) |
Endocrine | 163 (62.2%) |
T-DM1 | 55 (21.0%) |
Abemaciclib | 9 (3.4%) |
Number (%)/Median (Range) | |
---|---|
Type of axillary surgery | |
SLNB followed by ALND | 87 (33.2%) |
Direct ALND | 175 (66.8%) |
Number of SLNs | 1 (1–6) |
1 | 50/87 (57.5%) |
2 | 19/87 (21.8%) |
≥3 | 18/87 (20.7%) |
Data on non-SLNs | |
Number of evaluated non-SLNs | 12 (3–49) |
Number of metastatic non-SLNs | 1 (0–34) |
Nodal stage post-NAT | |
ypN0 | 66 (25.2%) |
ypNmi | 10 (3.8%) |
ypN1 | 92 (35.1%) |
ypN2 | 61 (23.3%) |
ypN3 | 33 (12.6%) |
Characteristics | ypN0-mi-1 (n = 168) | ypN2-3 (n = 94) | Univariate Analysis p-Value | Multivariate Analysis p-Value OR (95% CI) |
---|---|---|---|---|
Demographics | ||||
Age [years, mean (SD)] | 52.3 (11.2) | 54.5 (13.1) | 0.149 | - |
Menopausal status | ||||
Pre-menopausal | 72 (42.9%) | 32 (34.0%) | 0.162 | - |
Post-menopausal | 96 (57.1%) | 62 (66.0%) | - | |
NAT | ||||
NAT without anthracycline | ||||
Yes | 6 (3.6%) | 6 (6.4%) | 0.296 | - |
No | 162 (96.4%) | 88 (93.6%) | - | |
Completed cycles | ||||
Yes | 148 (88.1%) | 79 (84.0%) | 0.355 | - |
No | 20 (11.9%) | 15 (16.0%) | - | |
Immunotherapy | ||||
Yes | 78 (46.4%) | 20 (21.3%) | <0.001 a | 0.401 1.837 (0.444–7.602) |
No | 90 (53.6%) | 74 (78.7%) | - | - |
Pre-operative staging | ||||
Single nodule | ||||
Yes | 122 (72.6%) | 68 (72.3%) | 0.961 | - |
No | 46 (27.4%) | 104 (27.7%) | - | |
Dimension pre-NAT [mm, mean (SD)] | 34.3 (17.3) | 39.9 (18.2) | 0.034 a | 0.655 1.006 (0.979–1.034) |
Stage pre-NAT | ||||
cT1-2 | 130 (77.4%) | 61 (64.9%) | 0.029 a | 0.507 1.466 (0.473–4.540) |
cT3-4 | 38 (22.6%) | 33 (35.1%) | - | - |
cN0 | 18 (10.7%) | 3 (3.2%) | 0.031 a | 0.013 a 7.697 (1.537–38.550) |
cN+ | 150 (89.3%) | 91 (96.8%) | - | - |
Tumor | ||||
Subtype | ||||
HR+/HER2− | 55 (32.7%) | 65 (69.1%) | <0.001 a | 0.003 a 3.945 (1.602–9.716) |
Non-HR+/HER2− | 113 (67.3%) | 29 (30.9%) | - | - |
HER2+ | 72 (42.9%) | 12 (12.8%) | <0.001 a | 0.183 0.343 (0.071–1.656) |
Non-HER2+ | 96 (57.1%) | 82 (87.2%) | - | - |
Triple-negative | 41 (24.4%) | 17 (18.1%) | 0.237 | - |
Non-triple-negative | 127 (75.6%) | 77 (81.9%) | - | |
Histotype | ||||
Ductal | 157 (93.5%) | 82 (87.2%) | 0.088 | - |
Lobular | 11 (6.5%) | 12 (12.8%) | - | |
Dimension post-NAT [mm, mean (SD)] | 12.9 (17.8) | 29.9 (32.7) | <0.001 a | <0.001 a 1.043 (1.021–1.066) |
Surgery | ||||
BCS | 73 (43.5%) | 38 (40.4%) | 0.634 | - |
Mastectomy | 95 (56.5%) | 56 (59.6%) | - | |
SLNB followed by ALND | 59 (35.1%) | 28 (29.8%) | 0.379 | - |
Direct ALND | 109 (64.9%) | 66 (70.2%) | - | |
Number of evaluated non-SLNs | ||||
≤12 | 71 (42.3%) | 28 (29.8%) | 0.062 | - |
>12 | 97 (57.7%) | 66 (70.2%) | - |
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Gentile, D.; Canzian, J.; Barbieri, E.; Sagona, A.; Di Maria Grimaldi, S.; Tinterri, C. Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer. Cancers 2025, 17, 1596. https://doi.org/10.3390/cancers17101596
Gentile D, Canzian J, Barbieri E, Sagona A, Di Maria Grimaldi S, Tinterri C. Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer. Cancers. 2025; 17(10):1596. https://doi.org/10.3390/cancers17101596
Chicago/Turabian StyleGentile, Damiano, Jacopo Canzian, Erika Barbieri, Andrea Sagona, Simone Di Maria Grimaldi, and Corrado Tinterri. 2025. "Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer" Cancers 17, no. 10: 1596. https://doi.org/10.3390/cancers17101596
APA StyleGentile, D., Canzian, J., Barbieri, E., Sagona, A., Di Maria Grimaldi, S., & Tinterri, C. (2025). Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer. Cancers, 17(10), 1596. https://doi.org/10.3390/cancers17101596