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Omission of axillary lymph node dissection in patients with ypN+ breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06)

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Author(s)
Younghee ParkYoung Seob ShinKyubo KimKyung Hwan ShinJi Hyun ChangSu Ssan KimJin Hong JungWon ParkHaeyoung KimYong Bae KimSung Ja AhnMyungsoo KimJin Hee KimHye Jung ChaTae Gyu KimHae Jin ParkSun Young Lee
Keimyung Author(s)
Kim, Jin Hee
Department
Dept. of Radiation Oncology (방사선종양학)
Journal Title
Eur J Surg Oncol
Issued Date
2023
Volume
49
Issue
3
Keyword
Axillary lymph node dissectionBreast cancerNeoadjuvant chemotherapyResidual nodal diseaseSentinel lymph node biopsy
Abstract
Background:
We evaluated the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC).

Methods:
The medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. In total, 1273 patients from 12 institutions were included; all underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%). Univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed before and after propensity score matching (PSM).

Results:
The median follow-up was 75.3 months (range, 2.5-182.7). Axillary recurrence rates were 4.8% in the ALND group (n = 53) and 4.7% in the SLNBx group (n = 8). Before PSM, univariate analysis indicated that the 5-year OS rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002); multivariate analysis did not show a difference between groups (P = 0.325). After PSM, 258 and 136 patients were included in the ALND and SLNBx groups, respectively. There were no significant differences between the ALND and SLNBx groups in DFS (5-year rate, 75.8% vs. 76.9%, respectively; P = 0.406) or OS (5-year rate, 88.7% vs. 93.1%, respectively; P = 0.083).

Conclusions:
SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.
Keimyung Author(s)(Kor)
김진희
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1532-2157
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0748798322008277?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0748798322008277%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F
DOI
10.1016/j.ejso.2022.11.099
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44753
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학)
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