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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.

Affiliations

Younghee Park 1, Young Seob Shin 2, Kyubo Kim 3, Kyung Hwan Shin 4, Ji Hyun Chang 5, Su Ssan Kim 2, Jin Hong Jung 2, Won Park 6, Haeyoung Kim 6, Yong Bae Kim 7, Sung Ja Ahn 8, Myungsoo Kim 9, Jin Hee Kim 10, Hye Jung Cha 11, Tae Gyu Kim 12, Hae Jin Park 13, Sun Young Lee 14
1Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea.
2Department of Radiation Oncology, University of Ulsan College of Medicine, South Korea.
3Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea. Electronic address: kyubokim.ro@gmail.com.
4Department of Radiation Oncology, Seoul National University College of Medicine, South Korea. Electronic address: radiat@snu.ac.kr.
5Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
6Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
7Department of Radiation Oncology, Yonsei University College of Medicine, South Korea.
8Department of Radiation Oncology, Chonnam National University Medical School, South Korea.
9Department of Radiation Oncology, The Catholic University of Korea College of Medicine, South Korea.
10Department of Radiation Oncology, Keimyung University School of Medicine, South Korea.
11Department of Radiation Oncology, Yonsei University Wonju College of Medicine, South Korea.
12Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, South Korea.
13Department of Radiation Oncology, Hanyang University College of Medicine, South Korea.
14Department of Radiation Oncology, Jeonbuk National University School of Medicine, South Korea.