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Omission of Axillary Lymph Node Dissection in Patients with Residual Nodal Disease After Neoadjuvant Chemotherapy.
Limberg, Jessica N; Jones, Tyler; Thomas, Samantha M; Ntowe, Koumani W; Dalton, Juliet C; van den Bruele, Astrid Botty; Wang, Ton; Plichta, Jennifer K; Rosenberger, Laura H; DiNome, Maggie L; Chiba, Akiko.
Afiliación
  • Limberg JN; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  • Jones T; Duke Cancer Institute, Durham, NC, USA.
  • Thomas SM; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
  • Ntowe KW; Duke Cancer Institute, Durham, NC, USA.
  • Dalton JC; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
  • van den Bruele AB; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  • Wang T; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  • Plichta JK; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  • Rosenberger LH; Duke Cancer Institute, Durham, NC, USA.
  • DiNome ML; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  • Chiba A; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol ; 2024 Sep 04.
Article en En | MEDLINE | ID: mdl-39230856
ABSTRACT

BACKGROUND:

Axillary management after neoadjuvant chemotherapy (NAC) is evolving but axillary lymph node dissection (ALND) remains the standard of care for patients with residual nodal disease. The results of the Alliance A011202 trial evaluating the oncologic safety of ALND omission in this cohort are pending but we hypothesize that ALND omission is already increasing.

METHODS:

The National Cancer Database was queried to identify patients diagnosed with cT1-3N1M0 breast cancer who underwent NAC and had residual nodal disease (ypN1mi-2) from 2012 to 2021. Temporal trends in omission of completion ALND were assessed annually. Multivariable logistic and Cox regression models were used to identify factors associated with ALND omission and overall survival (OS), respectively.

RESULTS:

A total of 6101 patients were included; the majority presented with cT2 disease (57%), with 69% HER2+, 23% triple-negative, and 8% hormone receptor-positive/HER2-. Overall, 34% underwent sentinel lymph node biopsy (SLNB) alone. Rates of ALND were the lowest in the last 4 years of observation. After adjustment, treatment at community centers (vs. academic) and lower pathologic nodal burden were associated with omission of ALND. ALND omission was associated with a higher unadjusted OS (5-year OS 86% SLNB alone vs. 84% ALND; log-rank p = 0.03), however this association was not maintained after adjustment.

CONCLUSIONS:

Despite the impending release of the Alliance A011202 results, omission of ALND in patients with residual nodal disease after NAC is increasing. This practice appears more prominent in community centers and in patients with a lower burden of residual nodal disease. No association with OS was noted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos