Abstract
This study aimed to evaluate the prognosis of breast cancer patients who received neoadjuvant chemotherapy and underwent sentinel lymph node biopsy (SLNB) alone as axillary surgery regardless of their clinical and pathological lymph node status. We reviewed the records of 1,795 patients from Asan Medical Center who were diagnosed with stage I–III breast cancer and received neoadjuvant chemotherapy during 2003–2014. We selected 760 patients who underwent SLNB alone as axillary surgery and divided these patients into four groups according to their clinical lymph node (cN) and pathological lymph node (pN) status: cN(-)pN(-) (n = 377), cN(-)pN(+) (n = 33), cN(+)pN(-) (n = 242), and cN(+)pN(+) (n = 108). We then compared axillary lymph node recurrence, locoregional recurrence (LRR), distant metastasis-free survival (DMFS), and overall survival (OS) among the four groups using Kaplan–Meier analysis. We compared prognosis between the cN(-)pN(-) and cN(+)pN(-) groups to determine whether SLNB alone is an adequate treatment modality even in patients with cN positive pathology before neoadjuvant therapy but SLNB-negative pathology after NAC. The 5-year axillary recurrence rates in the cN(-)pN(-) and cN(+)pN(-) groups were 1.4% and 2.9%, respectively, and there was no significant difference between the two groups (p = 0.152). The axillary recurrence and LRR rates were significantly different among the four groups, with the pN-negative groups (cN[–]pN[–], cN[+]pN[–]) showing lower recurrence rates. DMFS and OS were also significantly different among the four groups, with the cN negative groups (cN[–]pN[–], cN[–]pN[+]) showing improved survival rates. Our study findings suggest that SLNB alone was associated with lower LRR rates even in patients with cN positive pathology before neoadjuvant therapy but cN negative pathology after SLNB. Moreover, recurrence and survival rates differ significantly according to clinical and pathological lymph node status.
Highlights
There has been an increase in the frequency of use of neoadjuvant chemotherapy (NAC) to minimize the surgical resection range in breast cancer patients who can be treated with surgery [1, 2]
The occurrence of complications caused by axillary lymph node dissection (ALND) can be possibly prevented by identifying metastasized nodes through sentinel lymph node biopsy (SLNB), which is less invasive than ALND [4]
axillary lymph nodes (ALNs) metastasis is one of the important factors that determine the prognosis of breast cancer patients
Summary
There has been an increase in the frequency of use of neoadjuvant chemotherapy (NAC) to minimize the surgical resection range in breast cancer patients who can be treated with surgery [1, 2]. Several clinical studies have confirmed the accuracy of SLNB, and SLNB has become the standard surgical procedure to determine the axillary stage in primary breast cancer patients who have a clinically LN negative status [5, 6]. According to a recent study, the identification rate of ALN metastasis through SLNB in patients with NAC was 89.6%, and its falsenegative rate (FNR) was 14.2% [7]. Since this FNR was higher than that in primary surgery patients, the oncological safety of SLNB-based surgery for these patients remains controversial
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