Omission of axillary surgery for ipsilateral breast tumor recurrence with negative nodes after previous breast-conserving surgery: is it oncologically safe?

Autor:	Qu FL; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Lin CJ; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Liu ZB; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Cao AY; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Wu J; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Liu GY; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Yu KD; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Di GH; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China., Li JJ; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. lijunjie5268@163.com.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. lijunjie5268@163.com.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. lijunjie5268@163.com., Shao ZM; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. zhimin_shao@yeah.net.; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. zhimin_shao@yeah.net.; Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. zhimin_shao@yeah.net.
Jazyk:	angličtina
Zdroj:	Breast cancer research and treatment [Breast Cancer Res Treat] 2022 Nov; Vol. 196 (1), pp. 97-109. Date of Electronic Publication: 2022 Aug 30.
DOI:	10.1007/s10549-022-06708-y
Abstrakt:	Purpose: Salvage mastectomy is traditionally recommended for patients who developed ipsilateral breast tumor recurrence (IBTR) in light of previous breast irradiation. However, it remains controversial whether surgical axillary staging (SAS) is necessary for IBTR patients with negative nodes. This study aimed to evaluate the oncologic safety of omitting SAS for IBTR. Methods: We retrospectively identified patients who developed invasive IBTR with negative nodes after undergoing breast-conserving surgery (BCS) from 2010 to 2018. Patterns of care in nodal staging were analyzed based on prior axillary staging status. Clinicopathologic characteristics and adjuvant treatment of the initial tumor, as well as the IBTR, were compared between the SAS and no SAS groups. Kaplan-Meier method and Cox regression model were utilized to compare the locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates after IBTR removal between the two groups. Results: A total of 154 IBTR patients were eligible for final analysis. Compared to the no SAS group, SAS group was less likely to undergo ALND (15.1 vs 73.3%, p < 0.001) at initial BCS, had a longer recurrence interval (2.8 vs 2.1 years, p = 0.03), and were more likely to have discordant molecular subtype (35.8 vs 12.9%, p = 0.001) and different quadrant location (37.7 vs 19.8%, p = 0.02) with primary tumor. However, the extent of axillary staging did not affect systemic or radiation recommendations. In the subgroup of patients without previous ALND, the clinicopathologic characteristics were roughly comparable. No significant differences were observed in LRRFS, DMFS or OS between the two groups. Conclusion: For node-negative IBTR patients, we observed selection bias on the basis of prior ALND, shorter recurrence interval, and concordant molecular subtype favoring no SAS but comparable LRRFS, DMFS, and OS. These results support a wider consideration of sparing SAS in the management of IBTR, especially in patients without previous ALND. (© 2022. The Author(s).)
Databáze:	MEDLINE
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