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Oncologic Outcomes for Different Axillary Staging Techniques in Patients with Nodal-Positive Breast Cancer Undergoing Neoadjuvant Systematic Treatment: A Cancer Registry Study

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Title: Oncologic Outcomes for Different Axillary Staging Techniques in Patients with Nodal-Positive Breast Cancer Undergoing Neoadjuvant Systematic Treatment: A Cancer Registry Study
Authors: André Pfob, Daria B. Kokh, Irina Surovtsova, Fabian Riedel, Philipp Morakis, Joerg Heil
Source: Ann Surg Oncol
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Adult, Sentinel Lymph Node Biopsy, Breast Neoplasms, Global Health Services Research, Middle Aged, Prognosis, Neoadjuvant Therapy, Survival Rate, 03 medical and health sciences, 0302 clinical medicine, Lymphatic Metastasis, Axilla, Humans, Lymph Node Excision, Female, Registries, Lymph Nodes, Lymph Nodes/pathology [MeSH], Female [MeSH], Follow-Up Studies [MeSH], Aged [MeSH], Adult [MeSH], Humans [MeSH], Breast cancer, Middle Aged [MeSH], Nodal positive, Sentinel Lymph Node Biopsy [MeSH], Axilla [MeSH], Lymph Node Excision [MeSH], Neoadjuvant Therapy [MeSH], Lymphatic Metastasis [MeSH], Neoplasm Staging [MeSH], Survival Rate [MeSH], Axillary staging, Prognosis [MeSH], Lymph Nodes/surgery [MeSH], Breast Neoplasms/surgery [MeSH], Cancer registry, Breast Neoplasms/pathology [MeSH], Registries [MeSH], Neoplasm Staging, Aged, Follow-Up Studies
Description: Background Targeted approaches such as targeted axillary dissection (TAD) or sentinel lymph node biopsy (SLNB) showed false-negative rates of < 10% compared with axillary lymph node dissection (ALND) in patients with nodal-positive breast cancer undergoing neoadjuvant systemic treatment (NAST). We aimed to evaluate real-world oncologic outcomes for different axillary staging techniques. Methods We identified nodal-positive breast cancer patients undergoing NAST from 2016 to 2021 from the state cancer registry of Baden-Wuerttemberg, Germany. Invasive disease-free survival (iDFS) was assessed using Kaplan–Meier statistics and multivariate Cox regression models (adjusted for age, ypN stage, ypT stage, and tumor biologic subtype). Results A total of 2698 patients with a median follow-up of 24.7 months were identified: 2204 underwent ALND, 460 underwent SLNB (255 with ≥ 3 sentinel lymph nodes [SLNs] removed, 205 with 1–2 SLNs removed), and 34 underwent TAD. iDFS 3 years after surgery was 69.7% (ALND), 76.6% (SLNB with ≥ 3 SLNs removed), 76.7% (SLNB with < 3 SLNs removed), and 78.7% (TAD). Multivariate Cox regression analysis showed no significant influence of different axillary staging techniques on iDFS (hazard ratio [HR] for SLNB with < 3 SLNs removed 0.96, 95% confidence interval [CI] 0.62–1.50; HR for SLNB with ≥ 3 SLNs removed 0.86, 95% CI 0.56–1.3; HR for TAD 0.23, 95% CI 0.03–1.64; ALND reference), and for ypN+ (HR 1.92, 95% CI 1.49–2.49), triple-negative breast cancer (HR 2.35, 95% CI 1.80–3.06), and ypT3-4 (HR 2.93, 95% CI 2.02–4.24). Conclusion These real-world data provide evidence that patient selection for de-escalated axillary surgery for patients with nodal-positive breast cancer undergoing NAST was successfully adopted and no early alarm signals of iDFS detriment were detected.
Document Type: Article
Other literature type
Language: English
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-024-15292-y
Access URL: https://pubmed.ncbi.nlm.nih.gov/38710911
https://repository.publisso.de/resource/frl:6499651
Rights: CC BY
Accession Number: edsair.doi.dedup.....38276d1b9e259129b0586eeb383e593a
Database: OpenAIRE
Description
Abstract:Background Targeted approaches such as targeted axillary dissection (TAD) or sentinel lymph node biopsy (SLNB) showed false-negative rates of < 10% compared with axillary lymph node dissection (ALND) in patients with nodal-positive breast cancer undergoing neoadjuvant systemic treatment (NAST). We aimed to evaluate real-world oncologic outcomes for different axillary staging techniques. Methods We identified nodal-positive breast cancer patients undergoing NAST from 2016 to 2021 from the state cancer registry of Baden-Wuerttemberg, Germany. Invasive disease-free survival (iDFS) was assessed using Kaplan–Meier statistics and multivariate Cox regression models (adjusted for age, ypN stage, ypT stage, and tumor biologic subtype). Results A total of 2698 patients with a median follow-up of 24.7 months were identified: 2204 underwent ALND, 460 underwent SLNB (255 with ≥ 3 sentinel lymph nodes [SLNs] removed, 205 with 1–2 SLNs removed), and 34 underwent TAD. iDFS 3 years after surgery was 69.7% (ALND), 76.6% (SLNB with ≥ 3 SLNs removed), 76.7% (SLNB with < 3 SLNs removed), and 78.7% (TAD). Multivariate Cox regression analysis showed no significant influence of different axillary staging techniques on iDFS (hazard ratio [HR] for SLNB with < 3 SLNs removed 0.96, 95% confidence interval [CI] 0.62–1.50; HR for SLNB with ≥ 3 SLNs removed 0.86, 95% CI 0.56–1.3; HR for TAD 0.23, 95% CI 0.03–1.64; ALND reference), and for ypN+ (HR 1.92, 95% CI 1.49–2.49), triple-negative breast cancer (HR 2.35, 95% CI 1.80–3.06), and ypT3-4 (HR 2.93, 95% CI 2.02–4.24). Conclusion These real-world data provide evidence that patient selection for de-escalated axillary surgery for patients with nodal-positive breast cancer undergoing NAST was successfully adopted and no early alarm signals of iDFS detriment were detected.
ISSN:15344681
10689265
DOI:10.1245/s10434-024-15292-y