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Oncologic Outcomes for Different Axillary Staging Techniques in Patients with Nodal-Positive Breast Cancer Undergoing
André Pfob1,2, Daria B Kokh3, Irina Surovtsova3
1Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany.
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.
Insights
De-escalated axillary surgery, including sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD), is safe for breast cancer patients after neoadjuvant treatment. Real-world data show no significant difference in invasive disease-free survival (iDFS) compared to axillary lymph node dissection (ALND).
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Neoadjuvant systemic treatment (NAST) is standard for nodal-positive breast cancer.
- Axillary lymph node dissection (ALND) has been the traditional approach.
- Targeted axillary dissection (TAD) and sentinel lymph node biopsy (SLNB) offer less invasive alternatives with previously reported low false-negative rates.
Purpose of the Study:
- To evaluate the real-world oncologic outcomes of different axillary staging techniques in patients with nodal-positive breast cancer undergoing NAST.
- To compare invasive disease-free survival (iDFS) rates between ALND, SLNB, and TAD.
Main Methods:
- Retrospective analysis of 2698 nodal-positive breast cancer patients from the German state cancer registry (2016-2021).
- Patients underwent either ALND, SLNB (with varying numbers of sentinel lymph nodes removed), or TAD after NAST.
- Invasive disease-free survival (iDFS) was assessed using Kaplan-Meier statistics and multivariate Cox regression, adjusted for relevant clinical factors.
Main Results:
- No significant difference in 3-year iDFS was observed between ALND (69.7%), SLNB (76.6%-76.7%), and TAD (78.7%).
- Multivariate analysis confirmed that axillary staging technique did not significantly influence iDFS.
- Factors such as positive nodal stage (ypN+), triple-negative breast cancer, and advanced tumor size (ypT3-4) were associated with worse iDFS.
Conclusions:
- Real-world data support the successful adoption of de-escalated axillary surgery in selected patients with nodal-positive breast cancer undergoing NAST.
- No early signs of detrimental effects on invasive disease-free survival were detected with SLNB or TAD compared to ALND.
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