# Nodal Response and Survival After Neoadjuvant Endocrine Therapy in Hormone Receptor-Positive Breast Cancer: 20-Year Experience from a Single Institution.

**Autores:** An SJ, Thai CHNC, Ismail S et al.
**Revista:** Ann Surg Oncol (2024)
**PMID:** 39154153 | **PMCID:** PMC11560637
**DOI:** [10.1245/s10434-024-16059-1](https://doi.org/10.1245/s10434-024-16059-1)
**Fuente:** PubMed Central (open access)

## Relevancia
Análisis de respuesta axilar y conversión a ypN0 en cáncer de mama HER2+ tratado con quimioterapia neoadyuvante anti-HER2; relevante para definir candidatas a desescalada quirúrgica axilar.

## Abstract
Axillary response to neoadjuvant endocrine therapy (NET) for the treatment of hormone receptor-positive breast cancer (HR+ BC) is not well-described. This study was designed to characterize nodal response after NET.

Patients receiving NET followed by curative intent surgery at a comprehensive cancer center from 1998 to 2022 in a prospectively collected registry were included. Patients with distant metastasis were excluded. Primary outcome was nodal pathologic complete response (pCR). Downstaging was defined as post-NET decrease in category.

We included 123 patients; the majority were cT2 (n = 59) or cT3 (n = 35), and cN0 (n = 81). Median age was 70.0 years (interquartile range 62.1-76.0). Forty-two patients (34.1%) were clinically node-positive. After NET, 73 (59.8%) underwent breast-conserving surgery. All patients underwent sentinel lymph node biopsy, and 12 (9.8%) underwent completion axillary lymph node dissection. In-breast downstaging was achieved in 51 (41.5%) patients, 1 (0.8%) had breast pCR, and 14 (11.4%) had breast upstaging. Axillary downstaging was achieved in 10 (23.8%), 6 patients (14.3%) had nodal pCR, and 14 (33.3%) had axillary upstaging. At 10-year follow-up, local recurrence was 1% and distant recurrence was 14%, while disease-free survival was 82%. After adjusting for demographic and clinical factors, age was the only characteristic associated with mortality (hazard ratio 1.07, 95% confidence interval 1.01-1.13).

In HR+ BC treated with NET, long-term disease-free survival is good, although nodal pCR is uncommon for cN+ patients. Future studies are needed to elucidate optimal neoadjuvant systemic therapy and to delineate oncologically safe strategies to deescalate axillary management for residual microscopic disease.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC11560637/

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*Datos de PubMed. Citar: doi 10.1245/s10434-024-16059-1*
