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Omission of axillary lymph node dissection in patients with ypN plus breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06)

Authors
 Younghee Park  ;  Young Seob Shin  ;  Kyubo Kim  ;  Kyung Hwan Shin  ;  Ji Hyun Chang  ;  Su Ssan Kim  ;  Jin Hong Jung  ;  Won Park  ;  Haeyoung Kim  ;  Yong Bae Kim  ;  Sung Ja Ahn  ;  Myungsoo Kim  ;  Jin Hee Kim  ;  Hye Jung Cha  ;  Tae Gyu Kim  ;  Hae Jin Park  ;  Sun Young Lee 
Citation
 EJSO, Vol.49(3) : 589-596, 2023-03 
Journal Title
EJSO
ISSN
 0748-7983 
Issue Date
2023-03
MeSH
Axilla / pathology ; Breast Neoplasms* / surgery ; Female ; Humans ; Lymph Node Excision / adverse effects ; Lymph Nodes / pathology ; Lymphatic Metastasis / pathology ; Neoadjuvant Therapy ; Neoplasm, Residual / pathology ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Sentinel Lymph Node* / pathology
Keywords
Axillary lymph node dissection ; Breast cancer ; Neoadjuvant chemotherapy ; Residual nodal disease ; Sentinel lymph node biopsy
Abstract
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S0748798322008277
DOI
10.1016/j.ejso.2022.11.099
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/199627
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