Reevaluating sentinel lymph node biopsy in older adults with T1 HR+/HER2- breast cancer: a SEER competing risk and nomogram study.

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Breast cancer (Tokyo, Japan) Pub Date : 2026-09-01 Epub Date: 2026-07-23 DOI:10.1007/s12282-026-01896-7

Ziqiang Wang, Yangyang Xie, Weijun Zhang, Xue Song, Qiwei Du, Nian Liu, Rongguo Li, Lanlan Gao

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Abstract

Background: Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging. However, its necessity in older patients (≥ 70 years) with HR+/HER2- T1 breast cancer remains debated in the context of contemporary de-escalation strategies. Existing evidence often incompletely accounts for the competing risk of death in this population. We evaluated the association between SLNB and breast cancer-specific death (BCSD) using real-world data.

Methods: Women aged ≥ 70 years with HR+/HER2- T1 (≤ 20 mm) breast cancer treated with breast-conserving surgery between 2010 and 2021 were identified from the SEER database and classified into SLNB and No-SLNB groups. Propensity score matching (PSM) and Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs) for BCSD and other-cause death (OCD). A prognostic nomogram was constructed.

Results: Among 47,838 eligible patients, 37,732 underwent SLNB and 10,106 did not. After PSM, SLNB was associated with a lower 5-year cumulative incidence of BCSD (2.50% vs. 3.50%); differences in OCD were also observed. In multivariable competing risk analysis, SLNB remained independently associated with reduced BCSD (sHR 0.69, 95% CI 0.60-0.80). The association was most pronounced in patients aged ≥ 80 years and those with T1c (11-20 mm) tumors, whereas the absolute risk difference was minimal in the 1-5 mm subgroup. The nomogram showed good discrimination (time-dependent AUC up to 0.821 in the training set and 0.857 in the validation set) and calibration.

Conclusions: In this real-world cohort, SLNB was associated with lower BCSD in older adults with HR+/HER2- T1 breast cancer, particularly in those aged ≥ 80 years or with T1c tumors. While the incremental value of SLNB appears limited in ultra-low-risk groups, age alone should not dictate omission of axillary staging. The nomogram may support individualized decision-making.

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重新评估老年T1 HR+/HER2-乳腺癌前哨淋巴结活检：SEER竞争风险和nomogram研究

背景：前哨淋巴结活检（SLNB）是腋窝分期的标准程序。然而，对于年龄较大（≥70岁）的HR+/HER2- T1乳腺癌患者，其必要性在当代降压策略的背景下仍存在争议。现有的证据往往不能完全解释这一人群的竞争死亡风险。我们使用真实数据评估SLNB与乳腺癌特异性死亡（BCSD）之间的关系。方法：从SEER数据库中筛选2010 - 2021年间接受保乳手术的年龄≥70岁的HR+/HER2- T1（≤20 mm）乳腺癌患者，分为SLNB组和No-SLNB组。使用倾向评分匹配（PSM）和细灰竞争风险模型来估计BCSD和其他原因死亡（OCD）的亚分布风险比（sHRs）。构建预后图。结果：在47,838例符合条件的患者中，37,732例接受了SLNB， 10,106例未接受SLNB。PSM后，SLNB与较低的BCSD 5年累积发病率相关（2.50% vs. 3.50%）；强迫症的差异也被观察到。在多变量竞争风险分析中，SLNB仍然与BCSD降低独立相关（sHR 0.69, 95% CI 0.60-0.80）。这种关联在年龄≥80岁和T1c （11-20 mm）肿瘤患者中最为明显，而在1-5 mm亚组中绝对风险差异最小。模态图具有良好的判别性（训练集的AUC随时间变化为0.821，验证集的AUC为0.857）和校准。结论：在这个现实世界的队列中，SLNB与老年HR+/HER2- T1乳腺癌患者的BCSD降低相关，特别是年龄≥80岁或T1c肿瘤患者。虽然SLNB的增加价值在超低风险人群中似乎有限，但年龄本身不应决定遗漏腋窝分期。nomogram可能支持个性化决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Breast cancer (Tokyo, Japan)

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