RT Journal Article
A1 Montagna, Giacomo
A1 Mrdutt, Mary M.
A1 Sun, Susie X.
A1 Hlavin, Callie
A1 Diego, Emilia J.
A1 Wong, Stephanie M.
A1 Barrio, Andrea V.
A1 van den Bruele, Astrid Botty
A1 Cabioglu, Neslihan
A1 Sevilimedu, Varadan
A1 Rosenberger, Laura H.
A1 Hwang, E. Shelley
A1 Ingham, Abigail
A1 Papassotiropoulos, Bärbel
A1 Nguyen-Sträuli, Bich Doan
A1 Kurzeder, Christian
A1 Aybar, Danilo Díaz
A1 Vorburger, Denise
A1 Matlac, Dieter Michael
A1 Ostapenko, Edvin
A1 Riedel, Fabian
A1 Fitzal, Florian
A1 Meani, Francesco
A1 Fick, Franziska
A1 Sagasser, Jacqueline
A1 Heil, Jörg
A1 Karanlık, Hasan
A1 Dedes, Konstantin J.
A1 Romics, Laszlo
A1 Banys-Paluchowski, Maggie
A1 Muslumanoglu, Mahmut
A1 Perez, Maria Del Rosario Cueva
A1 Díaz, Marcelo Chávez
A1 Heidinger, Martin
A1 Fehr, Mathias K.
A1 Reinisch, Mattea
A1 Tukenmez, Mustafa
A1 Maggi, Nadia
A1 Rocco, Nicola
A1 Ditsch, Nina
A1 Gentilini, Oreste Davide
A1 Paulinelli, Regis R.
A1 Zarhi, Sebastián Solé
A1 Kuemmel, Sherko
A1 Bruzas, Simona
A1 di Lascio, Simona
A1 Parissenti, Tamara K.
A1 Hoskin, Tanya L.
A1 Güth, Uwe
A1 Ovalle, Valentina
A1 Tausch, Christoph
A1 Kuerer, Henry M.
A1 Caudle, Abigail S.
A1 Boileau, Jean-Francois
A1 Boughey, Judy C.
A1 Kühn, Thorsten
A1 Morrow, Monica
A1 Weber, Walter P.
T1 Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy
JF JAMA Oncology
JO JAMA Oncol
YR 2024
DO 10.1001/jamaoncol.2024.0578
SN 2374-2437
AB Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown.To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node.In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis.Omission of ALND after SLNB or TAD.The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed.A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)–positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P < .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P < .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55).The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.
RD 5/20/2024
UL https://doi.org/10.1001/jamaoncol.2024.0578