Omission of axillary lymph node dissection in patients with ypN plus breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06)
- 주제(키워드) Breast cancer , Neoadjuvant chemotherapy , Residual nodal disease , Sentinel lymph node biopsy , Axillary lymph node dissection
- 주제(기타) Oncology; Surgery
- 설명문(일반) [Park, Younghee; Kim, Kyubo] Ewha Womans Univ, Coll Med, Dept Radiat Oncol, 1071 Anyangcheon Ro, Seoul 07985, South Korea; [Shin, Young Seob; Kim, Su Ssan; Jung, Jin Hong] Univ Ulsan, Coll Med, Dept Radiat Oncol, Ulsan, South Korea; [Shin, Kyung Hwan; Chang, Ji Hyun] Seoul Natl Univ, Coll Med, Dept Radiat Oncol, 101 Daehak Ro, Seoul 03080, South Korea; [Park, Won; Kim, Haeyoung] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Radiat Oncol, Seoul, South Korea; [Kim, Yong Bae] Yonsei Univ, Coll Med, Dept Radiat Oncol, Seoul, South Korea; [Ahn, Sung Ja] Chonnam Natl Univ, Med Sch, Dept Radiat Oncol, Gwangju, South Korea; [Kim, Myungsoo] Catholic Univ Korea, Coll Med, Dept Radiat Oncol, Seoul, South Korea; [Kim, Jin Hee] Keimyung Univ, Sch Med, Dept Radiat Oncol, Daegu, South Korea; [Cha, Hye Jung] Yonsei Univ, Wonju Coll Med, Dept Radiat Oncol, Seoul, South Korea; [Kim, Tae Gyu] Sungkyunkwan Univ, Samsung Changwon Hosp, Sch Med, Dept Radiat Oncol, Seoul, South Korea; [Park, Hae Jin] Hanyang Univ, Coll Med, Dept Radiat Oncol, Seoul, South Korea; [Lee, Sun Young] Jeonbuk Natl Univ, Sch Med, Dept Radiat Oncol, Jeonju, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 ELSEVIER SCI LTD
- 발행년도 2023
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000208848
- 본문언어 영어
- Published As https://doi.org/10.1016/j.ejso.2022.11.099
- PubMed 36470801
초록/요약
Background: We evaluated the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC). Methods: The medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. In total, 1273 patients from 12 institutions were included; all underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%). Univariate and multivariate an-alyses of disease-free survival (DFS) and overall survival (OS) were performed before and after propensity score matching (PSM). Results: The median follow-up was 75.3 months (range, 2.5-182.7). Axillary recurrence rates were 4.8% in the ALND group (n = 53) and 4.7% in the SLNBx group (n = 8). Before PSM, univariate analysis indicated that the 5-year OS rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002); multivariate analysis did not show a difference between groups (P = 0.325). After PSM, 258 and 136 patients were included in the ALND and SLNBx groups, respectively. There were no significant differences between the ALND and SLNBx groups in DFS (5-year rate, 75.8% vs. 76.9%, respectively; P = 0.406) or OS (5-year rate, 88.7% vs. 93.1%, respectively; P = 0.083). Conclusions: SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.(c) 2022 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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