Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer—A Single Center Experience

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article "Prognostic importance of nodal response to neoadjuvant systemic therapy on axillary surgery in breast cancer – single centre experience" offers a valuable insight into the evolving practice of breast cancer treatment, particularly the impact of neoadjuvant systemic therapy (NST) on axillary surgery decisions. The retrospective observational study focuses on patients with node-positive early-stage breast cancer treated at a single center, exploring the outcomes according to molecular subtypes and evaluating prognostic factors for axillary pathologic complete response (AXpCR), its influence on the extent of axillary surgery, and relapse-free survival (RFS).

Key findings highlight the significant rate of AXpCR following NST, especially in HER2-positive and triple-negative subtypes, and underscore the potential for surgical de-escalation in the axilla. The study suggests that achieving breast pathologic complete response (breast-pCR) is a strong predictor of AXpCR, allowing for less extensive surgeries like sentinel lymph node biopsy (SLNB) or SLNB combined with targeted axillary dissection, thereby reducing the morbidity associated with axillary lymph node dissection (ALND).

While the study is well-conducted and presents important data, there are opportunities for enhancement.

- The simple summary needs refinement for a clearer depiction of outcomes.

- The discussion would benefit from an expanded comparison with similar studies, specifically incorporating findings from recent research (PMID: 36980605) on the sentinel lymph node biopsy procedure post-neoadjuvant chemotherapy in breast cancer patients using the single tracer pre-operative injection.

Author Response

Dear Sir or Madam!

Thank you for your appreciated comments, which have been fully taken into account. Our replies and corrections are attached.

Thank you for taking the time to review!
Corresponding author on behalf of all authors

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

This is quite a hot topic at present with many trial being done prospectively to address the de-escalation of treatment.

The authors have already acknowledged some biases related to the study. Can the authors please clarify/elaborate on the following

1. The numbers ( in addition to percentages ) of   patient who achieved who achieved PCR based on molecular sub- types.

2. Total PCR was achieved in 35 patients( 38%) but only 8.7% patients received adjuvant chemotherapy . What were the indications for not offering chemotherapy to other patients ? 

3.How were patients with residual disease in the axilla treated?

4. Of the 72 patients who received radiotherapy, please elaborate if it was given to the breast, chest wall  and if axilla was included.

5. Of the patients who relapsed , how may were local, loco-regional and distant relapses ?

6. There are other factors which could influence RFS rather than Axillary PCR only as patients seem to receive different local and systemic treatment 

 

Author Response

Dear Sir or Madam!

Thank you for your appreciated comments, which have been fully taken into account. Our replies and corrections are attached.

Thank you for taking the time to review!
Corresponding author on behalf of all co-authors

Author Response File: Author Response.docx