ArticleAnnals of surgical oncology2026
Nodal Pathologic Response After Neoadjuvant Systemic Therapy in Clinically Advanced Node-Positive (cN2 and cN3) Breast Cancer.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
BACKGROUND/
objectivePatients with clinically advanced node-positive (cN2/3), non-metastatic breast cancer have traditionally undergone axillary lymph node dissection (ALND) after neoadjuvant systemic therapy (NST). Randomized de-escalation trials have excluded cN2/3 disease. However, some of these patients achieve nodal pathologic complete response (ypN0), suggesting potential for less extensive axillary surgery. We aimed to determine ypN0 rates and identify factors associated with nodal response.
methodsThe National Cancer Database (NCDB, 2004-2022) was analyzed. Female patients with cN2/3, non-metastatic breast cancer who received neoadjuvant chemotherapy (NAC) followed by surgery were included. Patients were stratified by pathologic nodal status. Clinicopathologic variables were compared, and multivariable logistic regression identified factors associated with pathologic complete response (pCR). Overall survival was analyzed using Kaplan-Meier methods.
resultsAmong approximately 4 million patients with breast cancer, 20,402 met the inclusion criteria. Of these, 36.9% (n = 7526) achieved ypN0 and 63.1% (n = 12,876) had residual nodal disease. ypN0 was associated with younger age (52 vs 54 years), higher Ki-67 (67% vs 42%), and higher tumor grade (37% vs 21% vs 11% for grades 3, 2, and 1, respectively; p < 0.001). Higher ypN0 rates were observed in human epidermal growth factor receptor 2-positive (70%), hormone receptor-negative (62%), and triple-negative tumors (57%), whereas hormone receptor-positive tumors had lower ypN0 rates (29%). Overall, pCR occurred in 22.6%. Despite this, 60.8% underwent ALND. Multivariable analysis showed that higher Ki-67 (odds ratio [OR] 1.29), younger age (OR 0.99 per year), and hormone receptor-negative status (OR 0.24) were associated with pCR (p < 0.001). pCR and ypN0 were associated with improved OS (hazard ratio 0.31 and 0.39, respectively; p < 0.001).
conclusionOver one-third of patients achieved ypN0 after NST. These findings highlight an opportunity to refine axillary management in selected cN2/3 patients.
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