{"entity":{"id":"rcb","kind":"term","name":"Residual cancer burden (RCB)","aka":[],"tldr":"A pathology score for how much cancer remains in the breast and lymph nodes after pre-surgery treatment, from 0 (none) to III (a large amount), combining tumour bed size, cellularity and nodal involvement. RCB-II or III after neoadjuvant therapy predicts a high risk of relapse and defines who enters escalation trials.","summary":"Residual cancer burden (RCB) is a score for how much cancer is left after pre-surgery treatment, running from 0 for none to III for a large amount. The index, developed at MD Anderson Cancer Center, combines tumour bed size, cellularity and nodal involvement, and an RCB-II or RCB-III result after neoadjuvant therapy predicts a high risk of relapse and defines populations for escalation trials, including ctDNA-guided and ADC-based post-neoadjuvant therapy. In this corpus it is attached to Triple-negative breast cancer (TNBC) and is used by the ASCENT-05 / OptimICE-RD and TROPION-Breast03 trials, by Laura J. Esserman, and by an idea on an ADC for residual disease after KEYNOTE-522. The KEYNOTE-522, OlympiA and KATHERINE papers also refer to it.","asOf":"2026-09-04","links":[{"label":"Residual cancer burden index (Symmans et al., J Clin Oncol 2007)","url":"https://doi.org/10.1200/JCO.2007.10.6823"},{"label":"Symmans, J Clin Oncol 2017: long-term prognosis by residual cancer burden and breast cancer subtype","url":"https://doi.org/10.1200/jco.2015.63.1010"},{"label":"Telli, Clin Cancer Res 2016: HRD score predicts response to platinum neoadjuvant chemotherapy in triple-negative breast cancer","url":"https://doi.org/10.1158/1078-0432.ccr-15-2477"},{"label":"Brierley et al., International Journal of Cancer 2026: the 9th edition of the UICC TNM classification of malignant tumours, updates and rationale for change (breast: the classification remains unchanged, the yp classification is clarified)","url":"https://doi.org/10.1002/ijc.70561"}],"tags":[],"related":[],"cancers":["tnbc","tnbc-early"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["tnm-breast-cancer-editions"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-symmans-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":["In triple-negative disease the residual cancer burden classes separate long-term risk sharply: ten-year relapse-free survival was 86 percent after a pathological complete response, 81 percent for RCB-I, 55 percent for RCB-II and 23 percent for RCB-III in the paclitaxel then FAC cohorts (Symmans 2017), which is why RCB-II and III residual disease is the setting for adjuvant escalation trials.","RCB 0 or I was the response endpoint that homologous recombination deficiency predicted in three neoadjuvant platinum trials (Telli 2016).","The staging manual now asks for it. The ninth edition of UICC TNM, recommended from 1 January 2026, clarifies that the ypT category must be based on the largest continuous focus of residual invasive cancer, excluding treatment-related fibrosis, with multiple foci carrying the m suffix, and recommends that the pathology report add an estimate of the extent of residual disease by the residual cancer burden method (Brierley 2026). Residual cancer burden is therefore no longer only a trial endpoint; it is what the stage cannot express."],"category":"Endpoints","wikipediaChecked":"2026-09-22"},"route":"/terms/rcb/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"her2-positive-early-breast-cancer","kind":"cancer","name":"Early HER2-positive breast cancer","route":"/cancers/her2-positive-early-breast-cancer/"},{"id":"tnbc-early","kind":"cancer","name":"Early triple-negative breast cancer","route":"/cancers/tnbc-early/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"term":[{"id":"ajcc-prognostic-stage-breast","kind":"term","name":"AJCC 8th edition prognostic stage for breast cancer","route":"/terms/ajcc-prognostic-stage-breast/"},{"id":"neoadjuvant-versus-adjuvant-breast","kind":"term","name":"Drugs before or after the operation","route":"/terms/neoadjuvant-versus-adjuvant-breast/"},{"id":"histological-response-induction","kind":"term","name":"Histological response to induction chemotherapy (osteosarcoma and Ewing sarcoma)","route":"/terms/histological-response-induction/"},{"id":"hrd-in-breast-cancer","kind":"term","name":"Homologous recombination deficiency (HRD) in breast cancer","route":"/terms/hrd-in-breast-cancer/"},{"id":"idfs","kind":"term","name":"Invasive disease-free survival (iDFS)","route":"/terms/idfs/"},{"id":"tnbc-residual-disease-decision","kind":"term","name":"Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point","route":"/terms/tnbc-residual-disease-decision/"},{"id":"tnbc-trials-open-today","kind":"term","name":"Triple-negative breast cancer trials open today (registry snapshot and UK sites)","route":"/terms/tnbc-trials-open-today/"},{"id":"tnm-breast-cancer-editions","kind":"term","name":"Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage","route":"/terms/tnm-breast-cancer-editions/"}],"paper":[{"id":"paper-create-x-adjuvant-capecitabine-nejm-2017","kind":"paper","name":"Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy","route":"/key-papers/paper-create-x-adjuvant-capecitabine-nejm-2017/"},{"id":"paper-radovich-ctdna-ctc-bre12-158-jama-oncol-2020","kind":"paper","name":"Association of Circulating Tumor DNA and Circulating Tumor Cells After Neoadjuvant Chemotherapy With Disease Recurrence in Patients With Triple-Negative Breast Cancer: Preplanned Secondary Analysis of the BRE12-158 Randomized Clinical Trial","route":"/key-papers/paper-radovich-ctdna-ctc-bre12-158-jama-oncol-2020/"},{"id":"paper-stecklein-ctdna-rcb-tnbc-residual-disease-npj-2023","kind":"paper","name":"ctDNA and residual cancer burden are prognostic in triple-negative breast cancer patients with residual disease","route":"/key-papers/paper-stecklein-ctdna-rcb-tnbc-residual-disease-npj-2023/"},{"id":"paper-telli-hrd-score-platinum-tnbc-ccr-2016","kind":"paper","name":"Homologous recombination deficiency (HRD) score predicts response to platinum-containing neoadjuvant chemotherapy in patients with triple-negative breast cancer","route":"/key-papers/paper-telli-hrd-score-platinum-tnbc-ccr-2016/"},{"id":"paper-katherine-nejm-2019","kind":"paper","name":"KATHERINE: switching to T-DM1 when HER2-positive breast cancer survives pre-surgery treatment","route":"/key-papers/paper-katherine-nejm-2019/"},{"id":"paper-keynote-522-nejm-2022","kind":"paper","name":"KEYNOTE-522: adding pembrolizumab before and after surgery in early triple-negative breast cancer","route":"/key-papers/paper-keynote-522-nejm-2022/"},{"id":"paper-symmans-rcb-long-term-prognosis-subtype-jco-2017","kind":"paper","name":"Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype","route":"/key-papers/paper-symmans-rcb-long-term-prognosis-subtype-jco-2017/"},{"id":"paper-symmans-j-clin-oncol","kind":"paper","name":"Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy","route":"/key-papers/paper-symmans-j-clin-oncol/"},{"id":"paper-olympia-nejm-2021","kind":"paper","name":"OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer","route":"/key-papers/paper-olympia-nejm-2021/"},{"id":"paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022","kind":"paper","name":"Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients","route":"/key-papers/paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022/"},{"id":"paper-liedtke-neoadjuvant-response-survival-tnbc-jco-2008","kind":"paper","name":"Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer","route":"/key-papers/paper-liedtke-neoadjuvant-response-survival-tnbc-jco-2008/"},{"id":"paper-turner-c-trak-tn-ctdna-pembrolizumab-ann-oncol-2023","kind":"paper","name":"Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer","route":"/key-papers/paper-turner-c-trak-tn-ctdna-pembrolizumab-ann-oncol-2023/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}],"idea":[{"id":"idea-post-neoadjuvant-adc","kind":"idea","name":"ADC for residual disease after KEYNOTE-522","route":"/ideas/idea-post-neoadjuvant-adc/"},{"id":"idea-tnbc-ctdna-guided-adjuvant-decisions","kind":"idea","name":"ctDNA-guided adjuvant decisions after residual disease: escalate the positive, spare the negative","route":"/ideas/idea-tnbc-ctdna-guided-adjuvant-decisions/"},{"id":"idea-tr2-neoadjuvant-combo-platform","kind":"idea","name":"Pre-surgery platform trials that test combinations on pathological response in months","route":"/ideas/idea-tr2-neoadjuvant-combo-platform/"}],"trial":[{"id":"a-brave","kind":"trial","name":"A-BRAVE","route":"/trials/a-brave/"},{"id":"ascent-05","kind":"trial","name":"ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)","route":"/trials/ascent-05/"},{"id":"bre12-158","kind":"trial","name":"BRE12-158 (Hoosier Oncology Group)","route":"/trials/bre12-158/"},{"id":"c-trak-tn","kind":"trial","name":"c-TRAK TN","route":"/trials/c-trak-tn/"},{"id":"calgb-40603","kind":"trial","name":"CALGB 40603 (Alliance)","route":"/trials/calgb-40603/"},{"id":"create-x","kind":"trial","name":"CREATE-X","route":"/trials/create-x/"},{"id":"ea1131","kind":"trial","name":"ECOG-ACRIN EA1131","route":"/trials/ea1131/"},{"id":"keynote-522","kind":"trial","name":"KEYNOTE-522","route":"/trials/keynote-522/"},{"id":"neopact","kind":"trial","name":"NeoPACT","route":"/trials/neopact/"},{"id":"phoenix","kind":"trial","name":"PHOENIX DDR/Anti-PD-L1","route":"/trials/phoenix/"},{"id":"swog-s1418","kind":"trial","name":"SWOG S1418 / NRG BR006","route":"/trials/swog-s1418/"},{"id":"tropion-breast03","kind":"trial","name":"TROPION-Breast03","route":"/trials/tropion-breast03/"}],"institution":[{"id":"md-anderson","kind":"institution","name":"MD Anderson Cancer Center","route":"/institutions/md-anderson/"}],"person":[{"id":"laura-esserman","kind":"person","name":"Laura J. Esserman","route":"/people/laura-esserman/"}]}}