Scholarlink

Introduction <p>The desire to reduce patient morbidity has led to de-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) for breast cancer; however, the impact of such de-escalation on oncologic outcomes is unknown.</p> Methods <p>We evaluated the relationship between axillary surgery type (sentinel lymph node [SLN] only vs. axillary lymph node dissection [ALND]) and 5-year outcomes in I-SPY2 trial patients from 2011 to 2022 who completed NAC and surgery. Rates of axillary recurrence (AxR), locoregional recurrence (LRR), distant recurrence-free survival (DRFS), and event-free survival (EFS) were compared.</p> Results <p>Of 1515 patients, SLN-only was performed in 804/1014 (79.3%) ypN0 patients and 127/501 (25.3%) ypN+ patients. Median follow-up time was 3.5 years. Most patients received adjuvant radiation (73.8% of ypN0 patients and 90.8% of ypN+ patients). In ypN0 cases, there was no difference between the SLN-only and ALND groups in 5-year estimated AxR (2.0% vs. 0.8%, <i>p</i>&#xa0;=&#xa0;0.57), LRR (4.6% vs. 4.4%, <i>p</i>&#xa0;=&#xa0;0.72), or EFS (88.3% vs. 86.4%, <i>p</i>&#xa0;=&#xa0;0.09). On multivariable analysis, SLN-only was associated with better DRFS (90.8% vs. 87.9%; hazard ratio [HR] 0.54, <i>p</i>&#xa0;=&#xa0;0.04). In ypN+ cases, there was no difference between the SLN-only and ALND groups in 5-year estimated AxR (5.2% vs. 3.6%, <i>p</i>&#xa0;=&#xa0;0.81), LRR (7.7% vs. 14%, <i>p</i>&#xa0;=&#xa0;0.13), DRFS (70.0% vs. 66.7%, <i>p</i>&#xa0;=&#xa0;0.09), or EFS (70.4% vs. 63.2%, <i>p</i>&#xa0;=&#xa0;0.07).</p> Conclusions <p>With short-term follow-up, omission of ALND in selected patients&#xa0;was not associated with worse AxR, LRR, DRFS, or EFS in patients with ypN0 or ypN+ disease. While prospective trial results are awaited, these data suggest that ALND may not be necessary for all patients with residual nodal disease after NAC.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Oncologic Outcomes with De-Escalation of Axillary Surgery After Neoadjuvant Chemotherapy for Breast Cancer: Results from > 1500 Patients on the I-SPY2 Clinical Trial

  • 期刊论文

  • 发表日期：

    2025年2月13日

查看全文
  • Judy C. Boughey,
  • Hongmei Yu,
  • Kayla Switalla,
  • Ladores Velle,
  • Alex Lopes,
  • Anne M. Wallace,
  • Rachel B. Lancaster,
  • Chantal R. Reyna,
  • Todd M. Tuttle,
  • Nora Jaskowiak,
  • Julia Tchou,
  • Roshni Rao,
  • Marie C. Lee,
  • Arpana M. Naik,
  • Mehra Golshan,
  • Cletus A. Arciero,
  • Candice A. M. Sauder,
  • Cindy B. Matsen,
  • Christina Yau,
  • Laura Esserman,
  • Rita A. Mukhtar

摘要

Introduction

The desire to reduce patient morbidity has led to de-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) for breast cancer; however, the impact of such de-escalation on oncologic outcomes is unknown.

Methods

We evaluated the relationship between axillary surgery type (sentinel lymph node [SLN] only vs. axillary lymph node dissection [ALND]) and 5-year outcomes in I-SPY2 trial patients from 2011 to 2022 who completed NAC and surgery. Rates of axillary recurrence (AxR), locoregional recurrence (LRR), distant recurrence-free survival (DRFS), and event-free survival (EFS) were compared.

Results

Of 1515 patients, SLN-only was performed in 804/1014 (79.3%) ypN0 patients and 127/501 (25.3%) ypN+ patients. Median follow-up time was 3.5 years. Most patients received adjuvant radiation (73.8% of ypN0 patients and 90.8% of ypN+ patients). In ypN0 cases, there was no difference between the SLN-only and ALND groups in 5-year estimated AxR (2.0% vs. 0.8%, p = 0.57), LRR (4.6% vs. 4.4%, p = 0.72), or EFS (88.3% vs. 86.4%, p = 0.09). On multivariable analysis, SLN-only was associated with better DRFS (90.8% vs. 87.9%; hazard ratio [HR] 0.54, p = 0.04). In ypN+ cases, there was no difference between the SLN-only and ALND groups in 5-year estimated AxR (5.2% vs. 3.6%, p = 0.81), LRR (7.7% vs. 14%, p = 0.13), DRFS (70.0% vs. 66.7%, p = 0.09), or EFS (70.4% vs. 63.2%, p = 0.07).

Conclusions

With short-term follow-up, omission of ALND in selected patients was not associated with worse AxR, LRR, DRFS, or EFS in patients with ypN0 or ypN+ disease. While prospective trial results are awaited, these data suggest that ALND may not be necessary for all patients with residual nodal disease after NAC.