Analysis Of Clinicopathological Factors Related To Axillary Lymph Node Negative Rate After Neoadjuvant Chemotherapy For Breast Cancer

background: With the development of systemic treatment of breast cancer,the pathological complete response rate of breast cancer patients is getting higher and higher.On the basis of ensuring the prognosis,how to improve the quality of life of breast cancer patients has become a focus of increasing attention.Among breast cancer postoperative complications,upper limb lymphedema is one of the main reasons for breast cancer patients to affect the quality of life after surgery.The most effective measure to reduce its incidence is to reduce the axillary lymph node dissection.To this end,we explored the clinicopathological factors associated with positive axillary lymph nodes to identify patients who are exempt from axillary lymph node dissection.Objective : For breast cancer patients undergoing neoadjuvant chemotherapy,explore the clinicopathological factors associated with the final pathological diagnosis of axillary lymph node negative status.Methods: According to the inpatient records of our hospital,collectthe information of patients who the first diagnosis date was January 1,2016,to August 31,2019 、 the clinical grade was cT1~4 N0~1 M0、 and the treatment regimen was undergo surgical treatment after the neoadjuvant chemotherapy.The molecular typing of the primary tumor and the corresponding axillary disease were compared.The clinicopathologic variables associated with negative axillary lymph nodes(ypN0)in the final examination were determined by multivariate analysis.Results:A total of 493 patients were included in this study for analysis.Among them,68 patients(13.79%)achieved breast complete pathological response(pCR)after neoadjuvant chemotherapy(NAC).Among patients who clinical lymph node negative(cN0),87.5%(21/24)of patients who achieved breast complete pathological response achieved ypN0,while 51.45%(89/173)patients who did not achieve breast pCR reached ypN0(P <0.001).Among patients who clinical lymph node positive(cN1),56.82%(25/44)of patients with breast pCR achieved ypN0,while19.44%(49/252)of patients with breast pCR reached ypN0(P<0.001).Patients with cN1(OR 0.208,95% CI 0.136 ~ 0.318)and patients who did not reach breast pCR(OR 0.194,95% CI 0.107~ 0.353)had a lower ratio of incidence of ypN0.Compared with Luminal A type,Luminal B type(OR 3.651,95% CI 1.685 ~ 7.913),HER-2 overexpression type(OR 3.275,95% CI 1.437 ~ 7.464),triple-negative type(OR 5.187,95% CI2.158 ~ 12.468)patients with axillary lymph node negative incidence ratioincreased.Conclusion: cN0 stage at first diagnosis and Breast pCR after neoadjuvant chemotherapy is closely related to reaches ypN0 after neoadjuvant chemotherapy,especially in patients with non-Luminal breast cancer.