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Abstract
Aim. To evaluate the long-term treatment outcomes of SLNB and ALND in patients who received NACT and achieved complete clinical regression in lymph nodes.
Materials and Methods. A retrospective cohort study was conducted which included data from 288 patients with no clinical lymph node involvement on the background of NACT between 2016 and 2023. 189 patients who underwent ALND were included in the control group. The experimental group comprised 99 patients who underwent ALND only. Patient characteristics were categorized according to the type of axillary surgery, with numeric variables presented as medians and ranges, and categorical data presented as frequencies (number and percentage). All statistical tests were two-sided and p-values below 0.05 were considered to be statistically significant.
Results. At a median follow-up of 60 months, locoregional recurrence was observed in three patients across different treatment groups. One patient in the ALD group (1/146, 0.6 %) had stage ypN1a and received adjuvant radiation therapy. In the BSLU group, followed by ALD, recurrence occurred in one patient (1/43, 2.3 %), who had a similar stage and received further adjuvant radiation therapy. One patient who underwent BSLU alone (1/99, 1 %) had ypN0 status and received adjuvant radiation therapy. Two cases of recurrence were accompanied by skin manifestations in patients who underwent mastectomy, and in one case recurrence was limited to the axillary region. During the entire follow-up period, 52 patients (18 %) died, including 42 (42/146, 28.8 %) from the ALD group and 10 (10/142, 7 %) from the BSLU group. To evaluate the long-term outcomes, patients were categorized according to the method of axillary surgery (BSLU or ALD). The overall survival (OS) in the BSLU group was 96.3 and 93.3 % after 3 and 5 years, respectively. In the ALD group, the rates were 86.3 and 80.8 % (p = 0.001). The recurrence-free survival (RFS) at 3 and 5 years was significantly higher in the BSLU group, at 90.1 and 85.2 % respectively, compared to 77.4 and 73.3 % in the ALD group (p = 0.005). The survival rate without distant metastases was also higher in the BSLU group, at 93.7 and 89.4 %, vs. 79.5 and 75.3 % in the ALD group (p = 0.001). The breast cancer-specific survival was higher in the BSLU group, reaching 97.9 and 95.7 % at 3 and 5 years, respectively, compared to 89.7 and 84.9 % in the ALD group (p = 0.002).
Conclusion. The difference in OS between the control and experimental groups suggests that these results are probably influenced by factors unrelated to the surgical approach. The choice of surgical approach has a significant impact on patients' quality of life.
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