Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy
Author(s)
Mary M. Mrdutt
Susie X. Sun
Callie Hlavin
Emilia J. Diego
Stephanie M. Wong
Andrea V. Barrio
Astrid Botty van den Bruele
Neslihan Cabıoğlu
Varadan Sevilimedu
Laura H. Rosenberger
E. Shelley Hwang
Abigail Ingham
Bärbel Papassotiropoulos
Bich Doan Nguyen-Sträuli
Christian Kurzeder
Danilo Díaz Aybar
Denise Vorburger
Dieter Michael Matlac
Edvin Ostapenko
Fabian Riedel
Florian Fitzal
Francesco Meani
Franziska Fick
Jacqueline Sagasser
Jörg Heil
Hasan Karanlık
Konstantin J. Dedes
László Romics
Maggie Banys‐Paluchowski
Mahmut Müslümanoğlu
María del Rosario Cueva Pérez
Marcelo Chávez Díaz
Martin Heidinger
Mathias K. Fehr
Mattea Reinisch
Mustafa Tükenmez
Nadia Maggi
Nicola Rocco
Nina Ditsch
Oreste Gentilini
Régis Resende Paulinelli
Sebastián Solé Zarhi
Sherko Küemmel
S. Bruz̆as
Simona Di Lascio
Tamara K. Parissenti
Tanya L. Hoskin
Uwe Güth
Valentina Ovalle
Christoph Tausch
Henry M. Kuerer
Abigail S. Caudle
Jean-François Boileau
Judy C. Boughey
Thorsten Kühn
Monica Morrow
William P. Weber
Date Issued
25 de abril de 2024
Type
Article
Volume
10
Issue
6
Start Page
793
End Page
793
Abstract
Importance: Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown. Objective: To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node. Design, Setting, and Participants: In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis. Exposure: Omission of ALND after SLNB or TAD. Main Outcomes and Measures: The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed. Results: A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)-positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P < .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P < .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55). Conclusions and Relevance: The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.
Subjects