# Contemporary Trends in Axillary Surgery for ER-Positive, HER2-Negative Breast Cancer Stratified by Neoadjuvant Endocrine Therapy, Neoadjuvant Chemotherapy, or Upfront Surgery

**Autores:** Sasha R Douglas, Samantha M Thomas, Akiko Chiba et al.
**Revista:** Ann Surg Oncol (2025)
**PMID:** 40986210 | **PMCID:** PMC12619107
**DOI:** [10.1245/s10434-025-18225-5](https://doi.org/10.1245/s10434-025-18225-5)
**Fuente:** PubMed Central (open access full-text)

## Relevancia
Análisis NCDB (n=792,581 ER+/HER2-) de tendencias contemporáneas en cirugía axilar tras NAC, NET o cirugía primaria. Tasa de conversión cN+ → ypN0 fue 19.6% con NAC vs 8.3% con NET. Documenta cómo los proveedores interpretan la enfermedad nodal residual de manera distinta según el tipo de terapia neoadyuvante.

## Abstract
De-escalation of axillary surgery for hormone receptor-positive breast cancer has gained traction, but guidelines for axillary management after neoadjuvant endocrine therapy (NET) remain ill-defined.

Female patients age ≥50 years with clinical T1-4c, N0-1, ER+/HER2- breast cancer (2012-2021) were selected from the National Cancer Database (NCDB) and divided into three groups based on treatment: upfront surgery, neoadjuvant chemotherapy (NAC), or NET. Axillary surgery was categorized as no axillary surgery, sentinel lymph node biopsy (SLNB) alone, sentinel lymph node biopsy followed by axillary lymph node dissection (ALND), or ALND alone. Descriptive analysis and logistic regression were used to identify factors associated with ALND, and survival analysis was performed.

The inclusion criteria were met by 792,581 patients. The majority underwent surgery first (94.3%), whereas 2.6% received NAC and 3.1% received NET. After adjustment, the odds of undergoing ALND were shown to be higher for those receiving NAC (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.12-1.24) or NET (OR, 1.10; 95% CI, 1.05-1.14) than for those receiving surgery first (p < 0.001). The patients receiving NET were less likely to convert from cN+ to ypN0 (8.3% vs NAC 19.6%; p < 0.001), but they still were less likely to undergo ALND after SLNB. Overall survival was highest among the patients in the surgery-first group regardless of clinical nodal status (p < 0.001).

Although the patients receiving NET had lower rates of nodal pathologic complete response, this did not translate to higher conversion to ALND after SLNB, suggesting that providers do not interpret residual nodal disease after NET the same way as after NAC.

## Texto completo
Texto completo disponible en PMC: [PMC12619107](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12619107/). El estudio analiza tendencias contemporáneas usando NCDB sobre cirugía axilar en cáncer ER+/HER2- según el tipo de tratamiento neoadyuvante. Documenta cómo la práctica clínica responde de manera diferenciada a la enfermedad nodal residual según el contexto (NAC vs NET), un aspecto crítico para la planificación del manejo axilar tras conversión incompleta cN+→ypN0.

---
*Datos de PubMed. Citar: doi 10.1245/s10434-025-18225-5*
