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Axillary lymph node dissection (ALND) in clinically node-positive breast cancer (BC) patients may lead to understaging. However, ALND did not influence systemic therapy decisions in this study.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • The role of axillary lymph node dissection (ALND) in guiding systemic therapy for clinically node-positive (cN+) breast cancer (BC) remains unclear.
  • Accurate nodal staging is crucial for tailoring treatment strategies in BC patients.

Purpose of the Study:

  • To investigate the association between ALND and systemic therapy recommendations in cN+ BC patients.
  • To evaluate the impact of ALND in both upfront surgery and post-neoadjuvant chemotherapy (NACT) settings.

Main Methods:

  • A prospective, observational cohort study involving 500 cN+ BC patients across 44 European centers.
  • Patients underwent tailored axillary surgery (TAS) followed by either ALND or axillary radiotherapy (ART) based on randomization.
  • Systemic therapy decisions were made at the discretion of local investigators.

Main Results:

  • In the upfront surgery setting, ALND did not significantly alter the proportion of patients receiving adjuvant chemotherapy or the type of systemic therapy.
  • Following NACT, ALND also showed no association with the choice or type of postneoadjuvant systemic therapy.
  • Patients without ALND were found to be significantly understaged regarding nodal burden.

Conclusions:

  • ALND may lead to understaging of nodal burden in cN+ breast cancer patients.
  • Despite potential understaging, ALND did not appear to influence systemic therapy recommendations in this cohort study.