Abstract P2-11-15: Axillary Pathologic Complete Response in Triple-Negative Breast Cancer Patients with Mammary Pathologic Complete Response: A Systematic Review
Bibliographic record
Abstract
Abstract Background: Neoadjuvant chemotherapy plays a crucial role in breast cancer by providing prognostic information through assessment of systemic treatment response. Response patterns can indicate which patients may have better survival outcomes and may benefit from less invasive therapies. Considering mammary and axillary responses, patients with HER2-positive and triple-negative subtypes exhibit higher rates of pathologic complete response (pCR). This study aimed to evaluate the rate of axillary pCR in triple-negative breast cancer patients achieving mammary pCR. Methods: This systematic review was conducted following the PRISMA protocol and was registered in PROSPERO (ID: 498121). PubMed, Embase, and Web of Science databases were searched. MESH Terms used were: ((((triple negative breast cancer) and (neoadjuvant chemotherapy)) and (lymph node)) and (axilla response)) and (breast response). Article screening was performed independently by two evaluators using the Rayyan platform. Pathologic complete response (pCR) was defined as the absence of invasive disease in the breast and axilla, with or without residual in situ disease after neoadjuvant chemotherapy (ypT0/ypTis/ypN0). Axillary pCR also included the absence of isolated tumor cells and micrometastases. Studies evaluating mammary and axillary pCR after neoadjuvant treatment in breast cancer patients, including triple-negative tumors, were included without restrictions on chemotherapy type or surgical procedures. Methodological quality assessment was conducted using the Newcastle-Ottawa Scale for cohort studies. Results: As of November 2023, 180 studies were retrieved, with ten cohort studies meeting the inclusion criteria, totaling 7,206 patients, of whom 30% had triple-negative tumors. Each of the 10 pre-selected articles, all cohort studies, underwent bias assessment using the Newcastle-Ottawa Scale. All 10 selected articles scored 6 or higher, indicating acceptable quality in their methodology and enabling inclusion in this systematic review. Among these, 42% had clinically positive axilla (cN+) prior to neoadjuvant chemotherapy, confirmed by cytologic examination in 419 cases and clinical or pathological examination in 2,575 cases. Axillary pCR rates were consistently higher than mammary pCR rates across the studies. In 9 out of the 10 selected articles, the rate of axillary pCR was higher than the rate of mammary pCR; in one of them, the rate was similar. In none of the evaluated articles was the mammary response rate higher than the axillary. The overall rates of pCR were 33.4% in the breast (ranging from 19 to 48%), 49.3% in the axilla (ranging from 25 to 92%), and 26.9% (ranging from 14 to 38%) for both sites combined in the triple-negative population. Conclusion: Despite high chemosensitivity in triple-negative breast cancer, rates of mammary pCR are consistently lower than the rates of axillary pCR. Factors beyond tumor subtype likely influence response patterns, indicating the need for further research to identify predictive biomarkers and optimize treatment strategies. Citation Format: Deize Azevedo Pereira, Milena Martello Cristófalo, Jonathan Yugo Maesaka, Yedda Nunes Reis, Gabriela Bezerra Nóbrega, José Maria Soares-Jr, Edmund Chada Baracat, José Roberto Filassi. Axillary Pathologic Complete Response in Triple-Negative Breast Cancer Patients with Mammary Pathologic Complete Response: A Systematic Review [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-11-15.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.048 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.010 |
| Bibliometrics | 0.010 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".