Does Neoadjuvant Chemotherapy in Clinical T1–T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?

Background Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1–2N0 TNBC. Methods The National Cancer Database (NCDB) was queried for women with operable cT1–2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND. Results Overall, 55,624 women were included: 26.9% ( n = 14,942) underwent NAC and 73.1% ( n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p