Controversial Opinion of “All pCRs are the Same” in St. Gallen International Consensus Guidelines 2021

The opinion of “all pCRs are the same” in St. Gallen International Consensus Guidelines 2021 attracted the attention from clinical doctors. But this opinion is not consistent with the current clinical practice guidelines. The evidence-based medical evidence supported that the survival benefit of pCR was associated with treatment regimes, initial staging, and tumor biomarkers. To compare with the different status, the survival prognosis of pCRs is not the same. Furthermore, the pretreatment clinical stage, pathological stage, tissue grade, and subtype still influence on the survival prognosis of pCR. The pCR should be stratified according to histological factors and to guide the identification of individualized treatment after neoadjuvant therapy. In the future, a de-escalation treatment might be detected by the clinical trials of neoadjuvant therapy which would approach “all pCRs are the same”.