Editor's Note: As neoadjuvant systemic therapy becomes increasingly integrated into breast cancer clinical practice, the principles and strategies guiding breast surgery are undergoing comprehensive transformation. Surgery is no longer an isolated local intervention. Instead, it is closely integrated with systemic treatment, playing a pivotal role in achieving a dynamic balance between precision-driven de-escalation and maintaining curative efficacy.How can clinicians define the appropriate boundaries of surgical de-escalation? What evidence is required for a de-escalation strategy to progress from a clinical trial into international guidelines? In which areas should China–Europe collaboration in breast cancer care and research focus its efforts?
The 2026 East China Breast Cancer Salon was held in Nanjing on October 10–11 under the theme “Ninety Years of Compassion and Dedication, Passing the Torch of Medical Excellence.” During the meeting, Oncology Frontier interviewed Professor Michael Gnant of the Medical University of Vienna, Austria, who shared international perspectives on the fundamental value of surgical decision-making in the era of neoadjuvant therapy, the evidence required to incorporate de-escalation strategies into clinical guidelines, and future directions for scientific collaboration between China and Europe in breast cancer surgery.
01
Oncology Frontier: Your presentation at this meeting focuses on “Surgical Considerations in the Context of Neoadjuvant Systemic Therapy.” As neoadjuvant therapy becomes increasingly widely used in breast cancer clinical practice, the principles and strategies of surgical management continue to evolve. From a surgeon’s perspective, what is the fundamental significance of neoadjuvant therapy for surgical decision-making? What key questions remain unresolved regarding surgical de-escalation and the preservation of long-term outcomes?
Professor Michael Gnant: Neoadjuvant systemic therapy is one of the major driving forces behind the development of modern breast surgery. It not only enables patients who were initially considered inoperable to undergo surgery, but also facilitates a shift from mastectomy toward breast-conserving treatment. We are steadily moving toward narrowing the indications for mastectomy.
In addition, tumor response patterns observed during neoadjuvant treatment provide important guidance for postoperative treatment planning. At least in certain breast cancer subtypes, pathological complete response (pCR) is a highly valuable prognostic indicator.
Nevertheless, several important questions remain controversial and require further validation through research. These include how best to apply surgical de-escalation principles to luminal breast cancer and whether established axillary surgery de-escalation strategies are equally applicable to patients who have received neoadjuvant systemic therapy.
02
Oncology Frontier: As Chair of the St. Gallen International Breast Cancer Consensus Conference, you have played an important role in shaping international breast cancer treatment recommendations. When considering de-escalation strategies such as breast-conserving surgery, omission of axillary lymph node dissection, and precision radiotherapy after neoadjuvant therapy, how should we determine whether a strategy can progress from de-escalation within a clinical trial to becoming an internationally accepted standard? Which key endpoints and indicators should be considered?
Professor Michael Gnant: Ultimately, overall survival remains the most fundamental endpoint. In early-stage breast cancer, improvements in overall survival often signify that clinical cure has been achieved.
In addition, the breast conservation rate is an important measure of outcomes in breast surgery. Minimizing adverse effects associated with both locoregional and systemic treatment, while continuously improving patients’ quality of life, is also essential to clinical decision-making.
03
Oncology Frontier: You have consistently promoted collaboration with the Chinese breast cancer research community. In your view, which areas should be prioritized in China–Europe collaboration on clinical research in breast cancer surgery? What aspects of the academic presentations by Chinese colleagues at this East China Breast Cancer Salon are of particular interest to you?
Professor Michael Gnant: In recent years, China has made remarkable progress in both breast cancer research and the quality of clinical care. Supported by leading academic institutions and specialized breast disease centers, China has significantly improved the quality of its scientific output and the standards of patient care.
The expansion of early detection programs, the development of clinical practice guidelines, and the improvement of quality assurance mechanisms have collectively strengthened China’s influence in the global breast cancer research community. Leading academic organizations, including the Breast Cancer Committee of the Chinese Society of Clinical Oncology (CSCO-BC) and the Breast Cancer Committee of the Chinese Anti-Cancer Association (CACA-CBCS), have played a particularly important role in this progress.
Looking ahead, I believe the next step is to further expand global collaborative initiatives. Cooperation should not be limited to industry partnerships. More importantly, we need to establish a robust and deeply integrated collaborative network encompassing academic research and clinical trials.
