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Comparison of survival outcomes for axillary surgery extent based on intraoperative sentinel lymph node biopsy result after neoadjuvant chemotherapy for breast cancer

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Abstract

Purpose

To investigate the survival difference between limited axillary surgery and full axillary lymph node dissection (ALND) in patients with 1–3 positive sentinel lymph node biopsies (SLNBs) after neoadjuvant chemotherapy (NAC).

Method

We retrospectively analyzed data from 676 patients who underwent surgery between 2007 and 2017 with cT1–4, cN0–3, cM0 breast cancer at the time of diagnosis and 1–3 positive SLNBs after NAC. The patients received either SLNB only or completed level I or II ALND based on SLNB results. After propensity score matching, 483 patients who had undergone SLNB only (n = 188) and ALND (n = 295) were included. We examined overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival and compared them between the subgroups.

Result

At a median follow-up of 59.4 months, no significant statistical difference was observed in overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival between SLNB only and ALND. No significant differences were observed in the 5-year axillary recurrence-free survival (93.1% vs. 94.0%, hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.43–2.05, p = 0.876) and 5-year overall survival (97.7% vs. 97.3%, HR = 1.65, 95% CI = 0.58–4.65, p = 0.347) between the two groups.

Conclusion

Our analysis suggests that SLNB alone may be a possible option for patients with 1–3 sentinel node-positive breast cancer following NAC without significant compromise of recurrence or overall survival.

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Acknowledgements

This study was supported by a grant (Elimination of Cancer Project Fund) from the Asan Cancer Institute of Asan Medical Center, Seoul (2017-1341).

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Jung Whan Chun, Jisun Kim, I. I. Yong Chung, Beom Seok Ko, Hee Jeong Kim, Jong Won Lee, Byung Ho Son, Sei-Hyun Ahn & Sae Byul Lee

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  1. Jung Whan Chun
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  2. Jisun Kim
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  3. I. I. Yong Chung
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  5. Hee Jeong Kim
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  6. Jong Won Lee
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  9. Sae Byul Lee
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Correspondence to Sae Byul Lee.

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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chun, J.W., Kim, J., Chung, I.I.Y. et al. Comparison of survival outcomes for axillary surgery extent based on intraoperative sentinel lymph node biopsy result after neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 187, 647–655 (2021). https://doi.org/10.1007/s10549-021-06249-w

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  • DOI: https://doi.org/10.1007/s10549-021-06249-w

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