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Background <p>Combination axillary lymph node dissection (ALND) and regional nodal irradiation (RNI) poses the greatest risk for breast cancer-related lymphedema. Despite interest in minimizing combination therapy (i.e., ALND+RNI) to avoid complications, concern remains over the oncologic safety of de-escalation in younger populations. This retrospective analysis explores the association between age and receipt of ALND+RNI to gain insight into patterns of axillary management.</p> Methods <p>Using the National Cancer Database (2018–2020), age-based differences in ALND+RNI among patients with stage I–III breast cancer undergoing surgery were examined. Patient and treatment characteristics were compared by age (&lt;45, 45–64, and ≥65 years). Multivariable regression assessed associations between age and treatment, adjusting for clinical factors.</p> Results <p>Among 439,790 patients, 7.5% were aged &lt;45 years, 45.2% were 45–64, and 47.3% were ≥65. Patients aged &lt;45 years (9.9%) were more commonly clinically node-positive (cN+) (vs 5.7% for age 45–64 and 5.5% for age ≥65 years; <i>p</i>&lt;0.001). Younger patients were more likely to undergo ALND (23.8% vs 17.0% vs 16.3%), RNI (23.1% vs 16.9% vs 12.9%), and ALND+RNI (10.6% vs 6.2% vs 4.6%) (all <i>p</i>&lt;0.001). On multivariable analysis, age &lt;45 years had the highest odds of ALND+RNI (odds ratio 1.11; 95% confidence interval 1.03–1.20 vs ≥65 years) overall, but age did not impact ALND+RNI among those receiving neoadjuvant chemotherapy (<i>p</i>=0.209). On sensitivity analyses, those with cN+ molecular subtypes were more likely to receive ALND+RNI than those with clinical N0 disease.</p> Conclusion <p>Women aged &lt;45 years are more likely to receive ALND+RNI. These data highlight an opportunity for further studies targeting management in younger cohorts to limit overtreatment.</p>

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Receipt of Combined Axillary Dissection and Nodal Irradiation Varies by Age

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月8日

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  • Sara P. Myers,
  • Yevgeniya Gokun,
  • Brandon Slover,
  • shley P. Davenport,
  • herese Y. Andraos,
  • Nerea Lopetegui-Lia,
  • Heather LeFebvre,
  • Daniel G. Stover,
  • Elizabeth A. Mittendorf,
  • Tari A. King,
  • Olga Kantor

摘要

Background

Combination axillary lymph node dissection (ALND) and regional nodal irradiation (RNI) poses the greatest risk for breast cancer-related lymphedema. Despite interest in minimizing combination therapy (i.e., ALND+RNI) to avoid complications, concern remains over the oncologic safety of de-escalation in younger populations. This retrospective analysis explores the association between age and receipt of ALND+RNI to gain insight into patterns of axillary management.

Methods

Using the National Cancer Database (2018–2020), age-based differences in ALND+RNI among patients with stage I–III breast cancer undergoing surgery were examined. Patient and treatment characteristics were compared by age (<45, 45–64, and ≥65 years). Multivariable regression assessed associations between age and treatment, adjusting for clinical factors.

Results

Among 439,790 patients, 7.5% were aged <45 years, 45.2% were 45–64, and 47.3% were ≥65. Patients aged <45 years (9.9%) were more commonly clinically node-positive (cN+) (vs 5.7% for age 45–64 and 5.5% for age ≥65 years; p<0.001). Younger patients were more likely to undergo ALND (23.8% vs 17.0% vs 16.3%), RNI (23.1% vs 16.9% vs 12.9%), and ALND+RNI (10.6% vs 6.2% vs 4.6%) (all p<0.001). On multivariable analysis, age <45 years had the highest odds of ALND+RNI (odds ratio 1.11; 95% confidence interval 1.03–1.20 vs ≥65 years) overall, but age did not impact ALND+RNI among those receiving neoadjuvant chemotherapy (p=0.209). On sensitivity analyses, those with cN+ molecular subtypes were more likely to receive ALND+RNI than those with clinical N0 disease.

Conclusion

Women aged <45 years are more likely to receive ALND+RNI. These data highlight an opportunity for further studies targeting management in younger cohorts to limit overtreatment.