Different strategies in de-escalation of axillary surgery in node-positive breast cancer following neoadjuvant treatment: a systematic review and meta-analysis of long-term outcomes

被引:1
作者
Man, Vivian [1 ]
Duan, Jiaxu [2 ]
Luk, Wing-Pan [3 ]
Fung, Ling-Hiu [3 ]
Kwong, Ava [4 ]
机构
[1] Univ Hong Kong, Queen Mary Hosp, Dept Surg, Div Breast Surg,Li Ka Shing Fac Med, Hong Kong, Peoples R China
[2] Univ Hong Kong Li Ka Shing, Univ Hong Kong Li Ka Shing Fac Med, Hong Kong, Peoples R China
[3] Hong Kong Sanat & Hosp, Med Phys & Res Dept, Hong Kong, Peoples R China
[4] Univ Hong Kong, Queen Mary Hosp, Dept Surg, Breast Surg Div,Li Ka Shing Fac Med, Hong Kong, Peoples R China
关键词
Breast cancer; Neoadjuvant chemotherapy; Sentinel lymph node biopsy; Targeted axillary dissection; PATHOLOGICAL COMPLETE RESPONSE; LYMPH-NODE; SENTINEL NODE; CONSERVING SURGERY; CHEMOTHERAPY; BIOPSY; MULTICENTER; DISSECTION; FEASIBILITY; THERAPY;
D O I
10.1007/s12282-025-01692-9
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeDifferent surgical options existed in the management of axilla among breast cancer patients who were initially node-positive and were converted node-negative after neoadjuvant systemic treatment (NST). De-escalation of axillary surgery was feasible, but previous studies focused on the false-negative rate (FNR) of respective procedures. The aim of this study is to evaluate the oncological outcomes of sentinel lymph-node biopsy (SLNB), MARI procedure, and targeted axillary dissection (TAD).Patients and methodsPubMed, Embase, and the Cochrane library literature databases were searched systematically. Studies were eligible if they addressed the axillary recurrence rate of patients with nodal pathological complete response (pCR) and omission of axillary lymph-node dissection (ALND) after NST. Pooled analysis was performed using inverse variance methods for logit transformed proportions.ResultsEleven retrospective studies and three prospective studies involving 4268 patients with node-positive breast cancers were included. A total of 1650 patients achieved nodal pCR and avoided ALND, 1382 patients with SLNB only and 268 patients with MARI/TAD. The pooled estimate of axillary recurrence was 2.1% (95%CI 1.4-3.2%) for patients with negative SLNB and 1.5% (95% CI 0.5-4.1%) for patients with negative MARI/TAD. There was no significant benefit of ALND over SLNB in patients with nodal pCR after NST. Pooled estimates of 5-year DFS, DDFS, and OS of SLNB alone were 0.87 (95% CI 0.83-0.90], 0.90 (95% CI 0.88-0.92), and 0.92 (95% CI 0.88-0.94), respectively.ConclusionBreast cancer patients who are converted node-negative after NST have extremely low nodal recurrence rate, irrespective of the choice of axillary surgery. Omission of ALND is oncologically safe in patients who have nodal pCR after NST.
引用
收藏
页码:638 / 653
页数:16
相关论文
共 53 条
[1]   How to perform a meta-analysis with R: a practical tutorial [J].
Balduzzi, Sara ;
Ruecker, Gerta ;
Schwarzer, Guido .
EVIDENCE-BASED MENTAL HEALTH, 2019, 22 (04) :153-160
[2]   Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study [J].
Banys-Paluchowski, Maggie ;
Gasparri, Maria Luisa ;
de Boniface, Jana ;
Gentilini, Oreste ;
Stickeler, Elmar ;
Hartmann, Steffi ;
Thill, Marc ;
Rubio, Isabel T. ;
Di Micco, Rosa ;
Bonci, Eduard-Alexandru ;
Niinikoski, Laura ;
Kontos, Michalis ;
Karadeniz Cakmak, Guldeniz ;
Hauptmann, Michael ;
Peintinger, Florentia ;
Pinto, David ;
Matrai, Zoltan ;
Murawa, Dawid ;
Kadayaprath, Geeta ;
Dostalek, Lukas ;
Nina, Helidon ;
Krivorotko, Petr ;
Classe, Jean-Marc ;
Schlichting, Ellen ;
Appelgren, Matilda ;
Paluchowski, Peter ;
Solbach, Christine ;
Blohmer, Jens-Uwe ;
Kuehn, Thorsten .
CANCERS, 2021, 13 (07)
[3]   Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy-A Rare Event [J].
Barrio, Andrea, V ;
Montagna, Giacomo ;
Mamtani, Anita ;
Sevilimedu, Varadan ;
Edelweiss, Marcia ;
Capko, Deborah ;
Cody, Hiram S., III ;
El-Tamer, Mahmoud ;
Gemignani, Mary L. ;
Heerdt, Alexandra ;
Kirstein, Laurie ;
Moo, Tracy-Ann ;
Pilewskie, Melissa ;
Plitas, George ;
Sacchini, Virgilio ;
Sclafani, Lisa ;
Tadros, Audree ;
Van Zee, Kimberly J. ;
Morrow, Monica .
JAMA ONCOLOGY, 2021, 7 (12) :1851-1855
[4]   Sentinel Node Biopsy After Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: The SN FNAC Study [J].
Boileau, Jean-Francois ;
Poirier, Brigitte ;
Basik, Mark ;
Holloway, Claire M. B. ;
Gaboury, Louis ;
Sideris, Lucas ;
Meterissian, Sarkis ;
Arnaout, Angel ;
Brackstone, Muriel ;
McCready, David R. ;
Karp, Stephen E. ;
Trop, Isabelle ;
Lisbona, Andre ;
Wright, Frances C. ;
Younan, Rami J. ;
Provencher, Louise ;
Patocskai, Erica ;
Omeroglu, Atilla ;
Robidoux, Andre .
JOURNAL OF CLINICAL ONCOLOGY, 2015, 33 (03) :258-U150
[5]   Identification and Resection of Clipped Node Decreases the False-negative Rate of Sentinel Lymph Node Surgery in Patients Presenting With Node-positive Breast Cancer (T0-T4, N1-N2) Who Receive Neoadjuvant Chemotherapy: Results From ACOSOG Z1071 (Alliance) [J].
Boughey, Judy C. ;
Ballman, Karla V. ;
Le-Petross, Huong T. ;
McCall, Linda M. ;
Mittendorf, Elizabeth A. ;
Ahrendt, Gretchen M. ;
Wilke, Lee G. ;
Taback, Bret ;
Feliberti, Eric C. ;
Hunt, Kelly K. .
ANNALS OF SURGERY, 2016, 263 (04) :802-807
[6]   Tumor Biology Correlates With Rates of Breast-Conserving Surgery and Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer Findings From the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial [J].
Boughey, Judy C. ;
McCall, Linda M. ;
Ballman, Karla V. ;
Mittendorf, Elizabeth A. ;
Ahrendt, Gretchen M. ;
Wilke, Lee G. ;
Taback, Bret ;
Leitch, A. Marilyn ;
Flippo-Morton, Teresa ;
Hunt, Kelly K. .
ANNALS OF SURGERY, 2014, 260 (04) :608-616
[7]   Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study [J].
Cabioglu, N. ;
Karanlik, H. ;
Yildirim, N. ;
Muslumanoglu, M. ;
Karadeniz, G. Cakmak ;
Can, D. Trabulus ;
Tukenmez, M. ;
Ersoy, Y. E. ;
Uras, C. ;
Zengel, B. ;
Emiroglu, S. ;
Polat, A. K. ;
Yeniay, L. ;
Ozkurt, E. ;
Kara, H. ;
Ibis, K. ;
Aydiner, A. ;
Ozmen, V ;
Igci, A. .
EJSO, 2021, 47 (10) :2506-2514
[8]   Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection [J].
Caudle, Abigail S. ;
Yang, Wei T. ;
Krishnamurthy, Savitri ;
Mittendorf, Elizabeth A. ;
Black, Dalliah M. ;
Gilcrease, Michael Z. ;
Bedrosian, Isabelle ;
Hobbs, Brian P. ;
DeSnyder, Sarah M. ;
Hwang, Rosa F. ;
Adrada, Beatriz E. ;
Shaitelman, Simona F. ;
Chavez-MacGregor, Mariana ;
Smith, Benjamin D. ;
Candelaria, Rosalind P. ;
Babiera, Gildy V. ;
Dogan, Basak E. ;
Santiago, Lumarie ;
Hunt, Kelly K. ;
Kuerer, Henry M. .
JOURNAL OF CLINICAL ONCOLOGY, 2016, 34 (10) :1072-+
[9]   Use of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Patients with Axillary Node-Positive Breast Cancer in Diagnosis [J].
Choi, Hee Jun ;
Kim, Isaac ;
Alsharif, Entad ;
Park, Sungmin ;
Kim, Jae-Myung ;
Ryu, Jai Min ;
Nam, Seok Jin ;
Kim, Seok Won ;
Yu, Jonghan ;
Lee, Se Kyung ;
Lee, Jeong Eon .
JOURNAL OF BREAST CANCER, 2018, 21 (04) :433-441
[10]  
Clinicaltrials.gov, About Us