Omission of axillary lymph node dissection in patients with ypN+ breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06)

Younghee Park, Young Seob Shin, Kyubo Kim, Kyung Hwan Shin, Ji Hyun Chang, Su Ssan Kim, Jin Hong Jung, Won Park, Haeyoung Kim, Yong Bae Kim, Sung Ja Ahn, Myungsoo Kim, Jin Hee Kim, Hye Jung Cha, Tae Gyu Kim, Hae Jin Park, Sun Young Lee

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2 Scopus citations


Background: We evaluated the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC). Methods: The medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. In total, 1273 patients from 12 institutions were included; all underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%). Univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed before and after propensity score matching (PSM). Results: The median follow-up was 75.3 months (range, 2.5–182.7). Axillary recurrence rates were 4.8% in the ALND group (n = 53) and 4.7% in the SLNBx group (n = 8). Before PSM, univariate analysis indicated that the 5-year OS rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002); multivariate analysis did not show a difference between groups (P = 0.325). After PSM, 258 and 136 patients were included in the ALND and SLNBx groups, respectively. There were no significant differences between the ALND and SLNBx groups in DFS (5-year rate, 75.8% vs. 76.9%, respectively; P = 0.406) or OS (5-year rate, 88.7% vs. 93.1%, respectively; P = 0.083). Conclusions: SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.

Original languageEnglish
Pages (from-to)589-596
Number of pages8
JournalEuropean Journal of Surgical Oncology
Issue number3
StatePublished - Mar 2023

Bibliographical note

Funding Information:
This work was supported by the National R&D Program for Cancer Control through the National Cancer Center (NCC) funded by the Ministry of Health & Welfare, Republic of Korea ( HA22C0044 ).

Publisher Copyright:
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology


  • Axillary lymph node dissection
  • Breast cancer
  • Neoadjuvant chemotherapy
  • Residual nodal disease
  • Sentinel lymph node biopsy


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