Table 4.

Patients to whom postoperative adjuvant chemotherapy after surgery is recommend

Risk of recurrence	Luminal HER2 negative	HER2 positive	Triple negative
Low risk	Waiver of chemotherapy	n/a	n/a
Intermediate risk and pN0b	• Chemotherapy is recommended for T 3 or above; • T1b-2: Subjected to 21-gene or 70-gene testing ① 21-gene testing: if age > 50 and RS > 25, then chemotherapy is recommended ② 21-gene testing: if age ≤ 50 and RS ≥ 16, then chemotherapy is recommended ③ 70-gene testing: if clinical data a and 70-gene test both show high risk, then chemotherapy is recommend ④ 70-gene testing: if clinical risk is high a and 70-gene test shows low risk and age ≤ 50, then chemotherapy should be considered •T1b-2: Those who have not done genetic testing and have any of the following characteristics can be considered for chemotherapy: low ER expression, histology grade 3, LVI positive, age < 35, high Ki67 • T1a: Chemotherapy can be generally waived, and when multiple risk factors are present, it should be considered comprehensively in an individualized manner.	• Chemotherapy is recommended if T1b or above • Chemotherapy should be considered if T1ad • Chemotherapy is generally not considered if T1mic, requiring further individualized comprehensive consideration	• Chemotherapy is recommended if T1b or above • Chemotherapy should be considered if T1a • Chemotherapy is generally not considered if T1mic
Intermediate risk and pN1	• Chemotherapy is recommended • Unless T1-2 and having the following 21-gene or 70-gene test results, chemotherapy waiver should be considered: ① 21-gene test: patients with RS ≤ 11 e; ② 70-gene test: clinical high risk a, 70-gene low-risk, and age > 50	n/a	n/a
High risk	Any	Any	Any

^aBased on the evaluation of the simplified version of Adjuvant! Online

^bITCs of pathological lymph nodes are managed the same way as pN₀, and pN_{1 mic} is managed the same way as pN₁

^cThe expert group believes that it is not yet possible to determine whether chemotherapy is needed based on the Ki67 index alone, but the higher the Ki67 index, the stronger the indication for chemotherapy.

^dAnti-HER2 monoclonal antibody therapy can be considered for T_1a, but there is no consensus on whether to combine it with intravenous chemotherapy. See the molecular subtype section for specific regimens.

^eAt present, this is mainly based on the data of the PLAN-B trial. Although the RXPONDER trial confirmed that postmenopausal patients with pN₁ and recurrence score (RS) < 25 may be exempt from chemotherapy, the results of that study need to be further verified and recognized.