In a German prospective registry study (SenTa) reported in JAMA Surgery, Kuemmel et al found that targeted axillary dissection alone after neoadjuvant systemic therapy was associated with outcomes similar to those obtained with targeted axillary dissection plus axillary lymph node dissection in women with node-positive breast cancer.
“The increasing use of neoadjuvant systemic therapy has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection. Targeted axillary dissection is feasible for axillary staging; however, data on oncological safety are scarce,” the investigators stated.
Study Details
In the multicenter registry study, 199 women with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node before neoadjuvant systemic therapy. After neoadjuvant systemic therapy, the marked lymph nodes and sentinel lymph nodes were excised (targeted axillary dissection), with axillary lymph node dissection then performed according to physician choice.
Key Findings
Among 199 patients, 182 had one to three suspicious nodes. A total of 119 underwent targeted axillary dissection alone, and 80 underwent targeted axillary dissection and axillary lymph node dissection. The median number of targeted axillary dissection lymph nodes excised was three (range = 1–11) in the targeted axillary dissection–alone group and two (range = 1–10) in the targeted axillary dissection/axillary lymph node dissection group.
A total of 145 patients had pathologic complete response (ypT0/Tis) after neoadjuvant systemic therapy; of them, 108 had ypN0. The ypN0 rate was higher in the targeted axillary dissection–alone group than in the targeted axillary dissection/axillary lymph node dissection group (79.0% vs 40.0%, P < .001).
Unadjusted 3-year invasive disease–free survival was 91.2% (95% confidence interval [CI] = 84.2%–95.1%) with targeted axillary dissection alone and 82.4% (95% CI = 71.5%–89.4%) with targeted axillary dissection/axillary lymph node dissection (P = .04). Axillary recurrence rates were 1.8% (95% CI = 0%–36.4%) with targeted axillary dissection alone and 1.4% (95% CI = 0%–54.8%) with targeted axillary dissection/axillary lymph node dissection (P = .56). On adjusted multivariate analysis, targeted axillary dissection alone was not associated with an increased risk of recurrence (hazard ratio [HR] = 0.83; 95% CI = 0.34–2.05, P = .69) or death (HR = 1.07, 95% CI = 0.31–3.70, P = .91).
The investigators concluded: “These results suggest that [targeted axillary dissection] alone in patients with mostly good clinical response to [neoadjuvant systemic therapy] and at least three [targeted axillary dissection lymph nodes] may confer survival outcomes and recurrence rates similar to [targeted axillary dissection] with [axillary lymph node dissection].”
Sherko Kuemmel, MD, PhD, of Kliniken Essen-Mitte, Germany, is the corresponding author of the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
