Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy
Abstract Axillary lymph node dissection (ALND) omission improves quality of life but is only considered under certain conditions. We investigated expanding these conditions in patients receiving neoadjuvant chemotherapy (NAC) for clinical N2–3, pathological N0 breast cancer. We retrospectively revie...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-04-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-024-84841-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849765493508931584 |
|---|---|
| author | Ee Jin Kim Tae Kyung Yoo Jisun Kim Il Yong Chung Beom Seok Ko Hee Jeong Kim Jong Won Lee Byung Ho Son Sae Byul Lee |
| author_facet | Ee Jin Kim Tae Kyung Yoo Jisun Kim Il Yong Chung Beom Seok Ko Hee Jeong Kim Jong Won Lee Byung Ho Son Sae Byul Lee |
| author_sort | Ee Jin Kim |
| collection | DOAJ |
| description | Abstract Axillary lymph node dissection (ALND) omission improves quality of life but is only considered under certain conditions. We investigated expanding these conditions in patients receiving neoadjuvant chemotherapy (NAC) for clinical N2–3, pathological N0 breast cancer. We retrospectively reviewed data of 1346 patients with clinical N2–3, M0, who underwent surgical resection (sentinel lymph node biopsy [SLNB] only, or level I–II ALND with/without SLNB) following NAC from January 2008 to December 2021. Univariate and multivariate analyses of overall (OS), disease-free (DFS), regional recurrence-free (RFS), and axillary recurrence-free survival (ARFS) were performed before and after propensity score matching (PSM) to control for confounding factors. Of the total patients, 521 (37.5%) achieved an axillary pathological complete response (ypN0). Of these, 293 (56.2%) underwent SLNB only. The median OS was 52.7 months. After PSM, SLNB-only and ALND groups showed no significant differences in ARFS (long-rank p = 0.765), RFS (long-rank p = 0.764), DFS (long-rank p = 0.186), and OS (long-rank p = 0.760). The 5-year ARFS (97.3 vs. 96.7%) and OS (97.7 vs. 97.3%) of both groups did not differ significantly. ALND omission after NAC in clinical N2-3, pathological N0 patients was not inferior to ALND,. Clinical N2-3 patients achieving ypN0 following NAC may be safely treated with SLNB alone. |
| format | Article |
| id | doaj-art-8d291c8199df4e85a5529d16504078b0 |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-8d291c8199df4e85a5529d16504078b02025-08-20T03:04:50ZengNature PortfolioScientific Reports2045-23222025-04-0115111010.1038/s41598-024-84841-yFeasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapyEe Jin Kim0Tae Kyung Yoo1Jisun Kim2Il Yong Chung3Beom Seok Ko4Hee Jeong Kim5Jong Won Lee6Byung Ho Son7Sae Byul Lee8Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterDivision of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical CenterAbstract Axillary lymph node dissection (ALND) omission improves quality of life but is only considered under certain conditions. We investigated expanding these conditions in patients receiving neoadjuvant chemotherapy (NAC) for clinical N2–3, pathological N0 breast cancer. We retrospectively reviewed data of 1346 patients with clinical N2–3, M0, who underwent surgical resection (sentinel lymph node biopsy [SLNB] only, or level I–II ALND with/without SLNB) following NAC from January 2008 to December 2021. Univariate and multivariate analyses of overall (OS), disease-free (DFS), regional recurrence-free (RFS), and axillary recurrence-free survival (ARFS) were performed before and after propensity score matching (PSM) to control for confounding factors. Of the total patients, 521 (37.5%) achieved an axillary pathological complete response (ypN0). Of these, 293 (56.2%) underwent SLNB only. The median OS was 52.7 months. After PSM, SLNB-only and ALND groups showed no significant differences in ARFS (long-rank p = 0.765), RFS (long-rank p = 0.764), DFS (long-rank p = 0.186), and OS (long-rank p = 0.760). The 5-year ARFS (97.3 vs. 96.7%) and OS (97.7 vs. 97.3%) of both groups did not differ significantly. ALND omission after NAC in clinical N2-3, pathological N0 patients was not inferior to ALND,. Clinical N2-3 patients achieving ypN0 following NAC may be safely treated with SLNB alone.https://doi.org/10.1038/s41598-024-84841-yBreast cancerNeoadjuvant chemotherapyAxillary lymph node dissectionSentinel lymph node biopsyClinical N2-3ALND omission |
| spellingShingle | Ee Jin Kim Tae Kyung Yoo Jisun Kim Il Yong Chung Beom Seok Ko Hee Jeong Kim Jong Won Lee Byung Ho Son Sae Byul Lee Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy Scientific Reports Breast cancer Neoadjuvant chemotherapy Axillary lymph node dissection Sentinel lymph node biopsy Clinical N2-3 ALND omission |
| title | Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy |
| title_full | Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy |
| title_fullStr | Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy |
| title_full_unstemmed | Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy |
| title_short | Feasibility of de-escalating axillary surgery in patients with clinical N2–3, pathological N0 breast cancer after neoadjuvant chemotherapy |
| title_sort | feasibility of de escalating axillary surgery in patients with clinical n2 3 pathological n0 breast cancer after neoadjuvant chemotherapy |
| topic | Breast cancer Neoadjuvant chemotherapy Axillary lymph node dissection Sentinel lymph node biopsy Clinical N2-3 ALND omission |
| url | https://doi.org/10.1038/s41598-024-84841-y |
| work_keys_str_mv | AT eejinkim feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT taekyungyoo feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT jisunkim feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT ilyongchung feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT beomseokko feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT heejeongkim feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT jongwonlee feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT byunghoson feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy AT saebyullee feasibilityofdeescalatingaxillarysurgeryinpatientswithclinicaln23pathologicaln0breastcancerafterneoadjuvantchemotherapy |