Oncologic outcomes for different axillary staging techniques in patients with nodal-positive breast cancer undergoing neoadjuvant systematic treatment

• Verfasst von: Pfob, André [VerfasserIn]
• Verfasst von: Kokh, Daria B. [VerfasserIn]
• Verfasst von: Surovtsova, Irina [VerfasserIn]
• Verfasst von: Riedel, Fabian [VerfasserIn]
• Verfasst von: Morakis, Philipp [VerfasserIn]
• Verfasst von: Heil, Jörg [VerfasserIn]
• Titel: Oncologic outcomes for different axillary staging techniques in patients with nodal-positive breast cancer undergoing neoadjuvant systematic treatment
• Titelzusatz: a cancer registry study
• Verf.angabe: André Pfob, MD, Daria B. Kokh, PhD, Irina Surovtsova, PhD, Fabian Riedel, MD, Philipp Morakis, MD, and Joerg Heil, MD
• E-Jahr: 2024
• Jahr: 6 May 2024
• Umfang: 12 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 18.03.2025
• Titel Quelle: Enthalten in: Annals of surgical oncology
• Ort Quelle: Berlin [u.a.] : Springer, 1994
• Jahr Quelle: 2024
• Band/Heft Quelle: 31(2024), 7, Seite 4381-4392
• ISSN Quelle: 1534-4681
• DOI: doi:10.1245/s10434-024-15292-y
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Adult
• Sach-SW: Aged
• Sach-SW: Axilla
• Sach-SW: Axillary staging
• Sach-SW: Breast cancer
• Sach-SW: Breast Neoplasms
• Sach-SW: Cancer registry
• Sach-SW: Female
• Sach-SW: Follow-Up Studies
• Sach-SW: Humans
• Sach-SW: Lymph Node Excision
• Sach-SW: Lymph Nodes
• Sach-SW: Lymphatic Metastasis
• Sach-SW: Middle Aged
• Sach-SW: Neoadjuvant Therapy
• Sach-SW: Neoplasm Staging
• Sach-SW: Nodal positive
• Sach-SW: Prognosis
• Sach-SW: Registries
• Sach-SW: Sentinel Lymph Node Biopsy
• Sach-SW: Survival Rate
• K10plus-PPN: 1919997199

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.