Equivalent survival in targeted axillary dissection compared to axillary lymph node dissection in patients with node positive breast cancer receiving neoadjuvant chemotherapy.
Callie Hlavin, Zainab Balogun, Danielle R Lavage, Michael S Cowher, Kristin Lupinacci, Quratulain Sabih, Atilla Soran, Jennifer G Steiman, Priscilla F McAuliffe, Emilia J Diego
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引用次数: 0
Abstract
Background: The role of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in node-positive breast cancer (N + BC) is evolving with opportunities to de-escalate surgery in those with complete axillary pathologic response. SLNB may lead to equivalent outcomes while avoiding the morbidity of axillary lymph node dissection (ALND).
Methods: This is a retrospective analysis of patients with N + BC who received NAC and targeted axillary dissection (TAD) with or without ALND from 2014 to 2021. Patients were categorized according to pathology of the previously positive radioactive seed marked lymph node into complete pathologic response (dSLN-) and persistent disease (dSLN+). We assessed the impact of axillary surgery on recurrence, disease-free survival (DFS), and overall survival (OS).
Results: We included 284 female patients with median follow-up of 36.3 months. 128 patients had dSLN-of which 13 (10.2%) had ALND and 115 (89.9%) had TAD. There were 156 dSLN+ patients: 107 (68.6%) ALND and 49 TAD. In both groups, TAD resulted in similar mortality (dSLN-: 15.4% vs. 8.9%, p=.309; dSLN+: 9.3% vs. 10.2%, p = 1.000), DFS (dSLN-:19.6 mos vs. 30.7 mos, p=.166; dSLN+: 30 mos vs. 37 mos, p=.650) and OS (dSLN-: 49.3 mos vs. 45.8 mos, p=.868; dSLN+: 36.4 months vs. 36.2 months, p=.982) compared to ALND.
Conclusion: For patients with dSLN-, there was no difference in recurrence, mortality, DFS, or OS between ALND and TAD. While there was a higher frequency of recurrence in patients who had dSLN + and underwent ALND compared to TAD, there was no difference in DFS or OS.
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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