De-escalation of axillary treatment in the event of a positive sentinel lymph node biopsy in cT1–2 N0 breast cancer treated with mastectomy: nationwide registry study (BOOG 2013-07)

• Published in: British journal of surgery 2024-04, Vol.111 (4)
• Main Authors: de Wild, Sabine R, van Roozendaal, Lori M, de Wilt, Johannes H W, van Dalen, Thijs, van der Hage, Jos A, van Duijnhoven, Frederieke H, Simons, Janine M, Schipper, Robert-Jan, de Munck, Linda, van Kuijk, Sander M J, Boersma, Liesbeth J, Linn, Sabine C, Lobbes, Marc B I, Poortmans, Philip M P, Tjan-Heijnen, Vivianne C G, van de Vijver, Koen K B T, de Vries, Jolanda, Westenberg, A Helen, Strobbe, Luc J A, Smidt, Marjolein L
• Format: Article
• Language: English
• Subjects: Axilla - pathology; Breast Neoplasms - pathology; Female; Humans; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - pathology; Mastectomy; Mastectomy, Segmental; Original; Registries; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy
• ISSN: 0007-1323; 1365-2168; 1365-2168
• DOI: 10.1093/bjs/znae077

Abstract Background Trials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1–2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis. Methods Women diagnosed in 2013–2014 with unilateral cT1–2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi–pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others. Results In total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths. Conclusion In this registry study of patients with cT1–2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients with cT1–2 N0 breast cancer treated with mastectomy, who have limited sentinel lymph node involvement. The 5-year regional recurrence rate was low (overall 1.3%) and comparable between treatment groups. Omitting completion axillary treatment appears to be safe in selected patients.