Discussion
tumor, triple-negative disease
TUMOR
To the authors’ knowledge, this was the first study to prospectively assess the role of ALND to determine nodal tumor burden to inform systemic therapy in patients with cN-positive BC. The main finding was that use of ALND and associated detailed knowledge of the number of positive nodes did not significantly change systemic therapy in the upfront surgery and postneoadjuvant setting. All patients underwent TAS, which was shown to selectively remove positive nodes while remaining much less radical than standard ALND.In recent years, gene expression profiles have been introduced to provide additional prognostic information in conjunction with nodal stage to inform systemic therapy recommendations in patients with luminal BC.The present study cannot address the impact of the MONARCHE trial on use of ALND for staging purposes in patients with cN-positive BC because it was published toward the end of the study period.The present study will be repeated once all 1500 patients have been randomly assigned to treatment groups in the TAXIS trial to investigate if future study findings may strengthen the role of ALND to determine the total number of positive nodes. However, morbidity is well documented to be increased after ALND compared with the SLN procedure.In the postneoadjuvant setting, patients with residual triple-negative disease showed improved oncologic outcomes when receiving capecitabine as did patients with residual 