Axillary Pathologic Complete Response as a Stronger Prognostic Marker than Breast pCR in Clinically Node-Positive Stage II–III Breast Cancer
Annals of Surgical Oncology, cilt.33, sa.8, ss.7169-7180, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 33 Sayı: 8
- Basım Tarihi: 2026
- Doi Numarası: 10.1245/s10434-026-19630-0
- Dergi Adı: Annals of Surgical Oncology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Sayfa Sayıları: ss.7169-7180
- Anahtar Kelimeler: Breast cancer, Neoadjuvant systemic therapy, Pathologic complete response, Axillary lymph nodes, Node-positive, Discordance, Prognosis, Survival
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Pathologic complete response (pCR) after neoadjuvant systemic therapy (NAST) predicts improved survival in breast cancer, but the relative prognostic value of breast versus axillary pCR in initially node-positive disease remains unclear. Methods: We analyzed 455 patients with clinically node-positive stage II–III breast cancer treated with NAST (2010–2022). Patients were classified by breast–axilla response patterns: both-site pCR (n = 99), breast-only pCR (n = 24), axilla-only pCR (n = 117), and neither pCR (n = 215). The primary endpoint was invasive disease-free survival (IDFS); overall survival (OS) was secondary. Multivariable Cox models assessed prognostic associations adjusted for clinicopathologic covariates. Results: Median follow-up was 57.2 months; 135 IDFS events, and 118 deaths occurred. In head-to-head analysis, axillary pCR showed numerically stronger prognostic associations than breast pCR (IDFS adjusted hazard ratio [aHR] 0.441 vs. 0.501; OS aHR 0.373 vs. 0.544). Compared with neither pCR, both-site pCR (IDFS aHR 0.217, 95% confidence interval [CI] 0.12–0.394) and pooled discordant response patterns achieving one-site pCR (aHR 0.464, 95% CI 0.304–0.709) demonstrated favorable outcomes, whereas breast-only pCR, observed in small, underpowered subgroup (n = 24), did not show a statistically significant benefit (aHR 0.928, P = 0.849). Five-year IDFS was 89% (both-site pCR), 77% (axilla-only pCR), 65% (breast-only pCR), and 63% (neither pCR). Findings remained robust in sensitivity analyses restricted to biopsy-confirmed node-positive patients and ALND-only subsets. Conclusions: In clinically node-positive breast cancer treated with NAST, axillary pCR showed numerically stronger prognostic associations than breast pCR, although this apparent difference should be interpreted cautiously. Post-neoadjuvant nodal status may help to refine risk stratification and inform adjuvant treatment planning.