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Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy

Abstract

Purpose

Studies that report equivalent oncologic outcomes of sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for T1-2N1mi breast cancers are heavily weighted with patients who received breast-conserving surgery (BCS). The impact of omitting ALND in N1mi patients treated with mastectomy is not well studied. It is also unknown if these patients would benefit from post-mastectomy radiotherapy (PMRT). This study reports the outcomes of patients with T1-2N1mi breast cancer treated by mastectomy without axillary therapy.

Methods

Patients who had T1-2N1mi breast cancer and underwent mastectomy from January 1998 to December 2018 were identified from our multi-institutional prospective database. Axillary recurrence rate (ARR), disease-free survival (DFS), and overall survival (OS) are reported.

Results

260 patients with pT1-2N1mi breast cancer who had mastectomy were identified. They had either SLNB (35.4%) or ALND (64.6%). Majority of these patients received adjuvant systemic therapy (93.8%). 77 (29.6%) patients received radiotherapy, 31 after SLNB and 46 after ALND. At median follow-up of 61 months, ARR was 1.1% (n = 1) in the SLNB only group, vs. 0.6% (n = 1) in the ALND group (p = 0.752). DFS and OS were not significantly different between patients with SLNB alone versus ALND (p = 0.40 and p = 0.27, respectively). Among 92 patients who had SLNB only, no DFS or OS difference was observed with the use of PMRT.

Conclusion

In T1-2N1mi patients with mastectomy and SLNB, axillary recurrences were rare. No statistically significant differences were noted between patients with SLNB, ALND, or PMRT. Our findings suggest that these patients may be safely treated without axillary therapy.

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Data Availability

The data are available and can be sent on request.

Code Availability

Not applicable.

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Acknowledgements

We thank our multi-institutional joint breast cancer registry investigators and collaborators, also Phyu Nitar and our Division of Cancer Informatics team for their support in maintaining our multi-institutional joint breast cancer registry. Joint Breast Cancer Registry investigators and collaborators: Wong Fuh Yong, Benita Tan Kiat Tee, Lim Swee Ho, Tan Su-Ming, Lim Sue Zann, Chay Wen Yee, Mabel Wong, Raymond Ng Chee Hui, Rebecca Dent, Yap Yoon Sim, Koo Si-Lin, Amit Jain, Tira Tan Jing Ying, Lita Chew, Vivianne Shih Lee Chuen, Chua Eu Tiong, Faye Lynette Lim Wei Tching, Richard Yeo Ming Chert, Jill Wong Su Lin, Preetha Madhukumar, Yong Wei Sean, Veronique Tan Kiak Mien, Wong Chow Yin, Tan Puay Hoon, Lim Geok Hoon, Lee Jung Ah, Ng Wee Loon, Wong Ruxin, Joanne Ngeow Yuen Yie, Lee Jie Xin Joycelyn, Tan Ying Cong Ryan, Lim Hsuen Elaine, Sim Yirong, Tan Qing Ting, Grace Kusumawidjaja, Bryan Ho Shihan, Gail Chua Wan Ying, Sharon Poh Shuxian, Jack Chan Junjie, Zhang Zewen, Sabrina Ngaserin Ng Hui Na, Chua Hui Wen, Lester Leong Chee Chao, Benjamin Tan Yongcheng, Mihir Ananta Gudi, Nurul Dinie Binte Rahadi, Phyu Nitar, Janice Tan Ser Huey, Joshua Lim Sheng Hao, Julie Liana Binte Hamzah, Tan Si Ying, Koh Yen Sin, Hanis Mariyah Binte Mohamed Ishak, Tan Hong Qi, Lloyd Tan Kuan Rui, Ghislaine Lee Su Xin, Sheriff Quek Zhan Hong, Nei Wen Long, Johan Chan, Joe Yeong Poh Sheng, Rayson Lee Rui Sheng, Rachel Sim, Eliza Sin, Nelson Yit, Melvin Chew Ming Long, Lim Sheng An, Mo JiaQi Michelle, Zubin Master.

Funding

This study is not funded.

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Authors and Affiliations

Authors

Contributions

SZ Lim, G Kusumawidjaja: Collection of data and creation of manuscript. HM Mohd Ishak: Statistical analyses. BKT Tan, SY Tan, JL Hamzah, P Madhukumar, WS Yong, CY Wong, Y Sim, GH Lim, SH Lim, SM Tan: Review of manuscript. FY Wong, VKM Tan: Creation and review of manuscript.

Corresponding author

Correspondence to Veronique Kiak Mien Tan.

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Conflict of interest

The authors have no conflict of interest.

Consent for Publication

Written-informed consent was obtained from all patients before treatment and for the inclusion into our multi-institutional breast cancer registry.

Ethical Approval

All procedures performed in our study are in accordance with the ethical standards of our institutional review board.

Informed Consent

Written-informed consent was obtained from all patients before treatment and for the inclusion into our multi-institutional breast cancer registry.

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Lim, S.Z., Kusumawidjaja, G., Mohd Ishak, H.M. et al. Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy. Breast Cancer Res Treat 189, 837–843 (2021). https://doi.org/10.1007/s10549-021-06341-1

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  • DOI: https://doi.org/10.1007/s10549-021-06341-1

Keywords

  • Nodal micrometastasis
  • Radiotherapy
  • Breast cancer
  • Sentinel lymph node biopsy
  • Axillary lymph node dissection