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<p>To investigate whether axillary lymph node dissection (ALND) can be waived with reference to the ACOSOG Z0011 trial inclusion criteria for triple-negative breast cancer (TNBC). A retrospective analysis was conducted on the clinicopathological data of 306 TNBC patients meeting the inclusion criteria of the ACOSOG Z0011 trial. Patients were divided into the ALND group (<i>n</i> = 184) and the sentinel lymph node biopsy (SLNB) group (<i>n</i> = 122) based on whether they underwent ALND. We compared general clinicopathological characteristics between the two groups, using propensity score matching (PSM) to balance intergroup differences. Disease-free survival (DFS) and overall survival (OS) were compared between the groups, and Cox proportional hazards regression models were employed to analyze prognostic factors in TNBC patients. Patients in the SLNB group had earlier initial pT staging than those in the ALND group (Stage I: 63.9% vs. 51.1%, <i>P</i> = 0.027) and more favorable Nottingham grades (Grade III: 27.9% vs. 42.4%, <i>P</i> = 0.030). Following PSM, 114 matched pairs were successfully generated. No statistically significant differences remained in baseline clinicopathological characteristics between the matched groups (all <i>P</i> &gt; 0.05). After PSM, the median follow-up durations were 103.0 months (95% CI: 91.6-114.4) for the ALND group and 89.0 months (95% CI: 79.5–98.5) for the SLNB group. No significant differences were observed in DFS rates (76.3% vs. 71.9%, <i>P</i> = 0.445) or OS rates (86.8 vs. 84.2%, <i>P</i> = 0.577). Cox proportional hazards regression analysis demonstrated that omitting ALND was neither an independent risk factor for DFS (HR = 1.234, 95% CI: 0.737–2.066, <i>P</i> = 0.423) nor for OS (HR = 1.248, 95% CI: 0.627–2.483, <i>P</i> = 0.528) in TNBC patients. Among TNBC patients meeting the ACOSOG Z0011 trial criteria, omission of ALND resulted in DFS and OS rates comparable to those achieved with ALND. Therefore, TNBC patients who maintain regular follow-up and receive standard adjuvant therapies postoperatively can safely forgo ALND following the Z0011 criteria.</p>

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Applicability of ACOSOG Z0011 Trial Criteria in Triple-Negative Breast Cancer Patients: A Propensity Score-Matching Study

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Kunjian Xia,
  • Zhenhua Sun,
  • Ding Li,
  • Lin Wang

摘要

To investigate whether axillary lymph node dissection (ALND) can be waived with reference to the ACOSOG Z0011 trial inclusion criteria for triple-negative breast cancer (TNBC). A retrospective analysis was conducted on the clinicopathological data of 306 TNBC patients meeting the inclusion criteria of the ACOSOG Z0011 trial. Patients were divided into the ALND group (n = 184) and the sentinel lymph node biopsy (SLNB) group (n = 122) based on whether they underwent ALND. We compared general clinicopathological characteristics between the two groups, using propensity score matching (PSM) to balance intergroup differences. Disease-free survival (DFS) and overall survival (OS) were compared between the groups, and Cox proportional hazards regression models were employed to analyze prognostic factors in TNBC patients. Patients in the SLNB group had earlier initial pT staging than those in the ALND group (Stage I: 63.9% vs. 51.1%, P = 0.027) and more favorable Nottingham grades (Grade III: 27.9% vs. 42.4%, P = 0.030). Following PSM, 114 matched pairs were successfully generated. No statistically significant differences remained in baseline clinicopathological characteristics between the matched groups (all P > 0.05). After PSM, the median follow-up durations were 103.0 months (95% CI: 91.6-114.4) for the ALND group and 89.0 months (95% CI: 79.5–98.5) for the SLNB group. No significant differences were observed in DFS rates (76.3% vs. 71.9%, P = 0.445) or OS rates (86.8 vs. 84.2%, P = 0.577). Cox proportional hazards regression analysis demonstrated that omitting ALND was neither an independent risk factor for DFS (HR = 1.234, 95% CI: 0.737–2.066, P = 0.423) nor for OS (HR = 1.248, 95% CI: 0.627–2.483, P = 0.528) in TNBC patients. Among TNBC patients meeting the ACOSOG Z0011 trial criteria, omission of ALND resulted in DFS and OS rates comparable to those achieved with ALND. Therefore, TNBC patients who maintain regular follow-up and receive standard adjuvant therapies postoperatively can safely forgo ALND following the Z0011 criteria.