Oncological Safety of Skipping Axillary Lymph Node Dissection in Patients with Clinical N0, Sentinel Node-Positive Breast Cancer Undergoing Total Mastectomy.

Autor: Chun JW; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Kang E; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Kim HK; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Lee HB; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Moon HG; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Lee JW; Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. jjjongwr@hanmail.net., Han W; Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea. hanw@snu.ac.kr.; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. hanw@snu.ac.kr.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 May; Vol. 31 (5), pp. 3168-3176. Date of Electronic Publication: 2024 Feb 17.
DOI: 10.1245/s10434-024-15049-7
Abstrakt: Objective: This study aimed to determine whether sentinel lymph node biopsy (SLNB) alone could afford oncological outcomes comparable with axillary lymph node dissection (ALND) in patients with early breast cancer without palpable lymphadenopathy who underwent total mastectomy (TM) and were SLN-positive.
Methods: This study analyzed clinical data of 6747 patients with breast cancer who underwent TM between 2014 and 2018 in two tertiary hospitals in Korea. Overall, 643 clinical stage T1-3 N0 patients who did not receive neoadjuvant therapy and had one to two metastatic SLNs at the time of surgery were included. Propensity score matching was performed between the SLNB alone and ALND groups, adjusting for clinical T stage and number of metastatic SLNs. In total, 237 patients were allocated to each group.
Results: Mean number of metastatic SLNs was 1.2 for the SLNB group and 1.6 for the ALND group. With a median follow-up of 65.0 months, 5 year disease-free survival was 90.8% for the SLNB group and 93.9% for the ALND group (hazard ratio [HR] 1.35, 95% confidence interval [CI] 0.70-2.58; p = 0.36). 5 year ipsilateral locoregional recurrence-free survival (LRRFS) was not significantly different between the two groups (95.1% and 98.3% for the SLNB and ALND groups, respectively) [HR 1.86, 95% CI 0.69-5.04; p = 0.21]. In the SLNB group, patients who received radiation therapy (RT) showed superior 5 year LRRFS than patients who did not receive RT (100% vs. 92.9%; p = 0.02).
Conclusion: Collectively, our findings suggest that SLNB could afford comparable outcomes to ALND in patients with early breast cancer and one to two metastatic SLNs who underwent TM. Importantly, RT could decrease locoregional recurrence in patients who underwent SLNB alone.
(© 2024. The Author(s).)
Databáze: MEDLINE
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