Abstract
To investigate the survival difference between limited axillary surgery and full axillary lymph node dissection (ALND) in patients with 1-3 positive sentinel lymph node biopsies (SLNBs) after neoadjuvant chemotherapy (NAC). We retrospectively analyzed data from 676 patients who underwent surgery between 2007 and 2017 with cT1-4, cN0-3, cM0 breast cancer at the time of diagnosis and 1-3 positive SLNBs after NAC. The patients received either SLNB only or completed level I or II ALND based on SLNB results. After propensity score matching, 483 patients who had undergone SLNB only (n = 188) and ALND (n = 295) were included. We examined overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival and compared them between the subgroups. At a median follow-up of 59.4months, no significant statistical difference was observed in overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival between SLNB only and ALND. No significant differences were observed in the 5-year axillary recurrence-free survival (93.1% vs. 94.0%, hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.43-2.05, p = 0.876) and 5-year overall survival (97.7% vs. 97.3%, HR = 1.65, 95% CI = 0.58-4.65, p = 0.347) between the two groups. Our analysis suggests that SLNB alone may be a possible option for patients with 1-3 sentinel node-positive breast cancer following NAC without significant compromise of recurrence or overall survival.
Highlights
Many breast cancer patients with clinically node-positive biopsy receive preoperative chemotherapy for a possible reduction of tumor burden and surgical extent
Our analysis suggests that sentinel lymph node biopsies (SLNBs) alone may be a possible option for patients with 1-3 sentinel node-positive breast cancer following Neoadjuvant chemotherapy (NAC) without significant compromise of recurrence or overall survival
Neoadjuvant chemotherapy (NAC) reduces the need for axillary lymph node dissection (ALND), and sentinel lymph node biopsy (SLNB) is an appropriate method of determining nodal status after NAC. [1,2,3] The presence of axillary node metastasis during SLNB is an important factor in making treatment decisions in breast cancer
Summary
Many breast cancer patients with clinically node-positive biopsy receive preoperative chemotherapy for a possible reduction of tumor burden and surgical extent. Neoadjuvant chemotherapy (NAC) reduces the need for axillary lymph node dissection (ALND), and sentinel lymph node biopsy (SLNB) is an appropriate method of determining nodal status after NAC. For primary breast cancer patients without NAC, according to the recent National Comprehensive Cancer Network (NCCN) guidelines, no further axillary surgery for positive sentinel lymph node (SLN) can be considered if micrometastasis is seen in SLN or if the patient meets all of the following criteria from the ACOSOG Z0011 trial: T1 or T2 tumor, 1 or 2 positive SLNs, breast-conserving surgery and planned whole breast radiation therapy, and no preoperative chemotherapy. For patients who presented with node-positive breast cancer after NAC, ALND has been the standard surgical method of choice. According to Almahariq et al, slightly over a quarter of patients with ypN1 breast cancer did not undergo an ALND in the National Cancer Data Base-affiliated institutions in 2014
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