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The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b–N3c Disease Who Receive Adjuvant Radiotherapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For breast cancer with advanced regional lymph node involvement, axillary lymph node dissection (ALND) remains the standard of care for staging and treating the axilla despite the presence of undissected lymph nodes. The benefit of ALND in this setting is unknown.

Objectives

We sought to describe national patterns of care of axillary surgery and its association with overall survival (OS) among women with cN2b–N3c breast cancer who receive adjuvant radiotherapy.

Patients and Methods

We identified female patients with cN2b–N3c breast cancer from 2012 to 2017 from the National Cancer Database. Clinical and demographic information were analyzed using Wilcoxon rank sum and χ2 tests. Predictors of receipt of ALND and predictors of death were identified with multivariable logistic regression modeling. Inverse probability of treatment weighting was implemented to adjust for differences in treatment cohorts. The Kaplan–Meier method was used to evaluate OS.

Results

We identified 7167 patients. Of these, 922 (13%) received SLNB and 6254 (87%) received ALND; 7% were cN2b, 19% cN3a, 24% cN3b, 19% cN3c, and 31% cN3, not otherwise specified. Predictors of receipt of ALND were age 50–69 years [odds ratio (OR) 1.3, p < 0.01], cN3a (OR 7.6, p < 0.01), cN3b (OR 2.8, p < 0.01), and cN3c (OR 4.2, p < 0.01). Predictors of death included cN3c (OR 1.9, p < 0.01), age 70–90 years (OR 1.5, p = 0.01), and positive surgical margins (OR 1.5, p < 0.01). After cohort balancing, ALND was not associated with improved OS when compared with SLNB (HR 0.99, p = 0.91).

Conclusions

ALND in patients with advanced nodal disease was not associated with improved survival compared with SLNB for women who receive adjuvant radiotherapy.

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Data Availability

All National Cancer Database (NCDB) data is available through the American College of Surgeons. Research STATA code available upon request.

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Acknowledgement

The authors would like to thank Kiramey Gilleese for her assistance in editing and formatting for submission.

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Authors and Affiliations

  1. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA

    Eric A. Roach MD & Christopher R. Weil MD

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher R. Weil MD

  3. Department of Radiation Oncology, Intermountain Healthcare, Murray, UT, USA

    George Cannon MD, Jon Grant MD & Dustin Boothe MD

  4. Department of Hematology/Oncology, Intermountain Healthcare, Murray, UT, USA

    Margaret Van Meter MD

Authors
  1. Eric A. Roach MD
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  2. Christopher R. Weil MD
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Correspondence to Eric A. Roach MD.

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10434_2024_15280_MOESM1_ESM.docx

Supplementary file 1 Standardized mean differences across covariates. The model was designed to keep all covariates within an absolute value of 0.1 SMD, with values 0.05 denoting a very closely balanced match. (DOCX 162 kb)

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Roach, E.A., Weil, C.R., Cannon, G. et al. The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b–N3c Disease Who Receive Adjuvant Radiotherapy. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15280-2

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