Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

Sherko Kuemmel; Joerg Heil; Simona Bruzas; Elisabeth Breit; Dorothea Schindowski; Hakima Harrach; Ouafaa Chiari; Karin Hellerhoff; Elena Bensmann; Volker Hanf; Sven-Thomas Graßhoff; Petra Deuschle; Kerstin Belke; Silke Polata; Stefan Paepke; Mathias Warm; Johannes Meiler; Christian Schindlbeck; Wencke Ruhwedel; Ulrike Beckmann; Ulrich Groh; Peter Dall; Jens-Uwe Blohmer; Alexander Traut; Mattea Reinisch

doi:10.1001/jamasurg.2023.1772

Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

Sherko Kuemmel
, Joerg Heil
, Simona Bruzas
, Elisabeth Breit
, Dorothea Schindowski
, Hakima Harrach
, Ouafaa Chiari
, Karin Hellerhoff
, Elena Bensmann
, Volker Hanf
, Sven-Thomas Graßhoff
, Petra Deuschle
, Kerstin Belke
, Silke Polata
, Stefan Paepke
, Mathias Warm
, Johannes Meiler
, Christian Schindlbeck
, Wencke Ruhwedel
, Ulrike Beckmann

Ulrich Groh, Peter Dall, Jens-Uwe Blohmer, Alexander Traut, Mattea Reinisch

Traunstein Hospital

Interdisciplinary Breast Unit
Department of Obstetrics and Gynecology
Breast Unit
Breast Unit Klinikum Fürth
Klinik für Gynäkologie und Geburtshilfe
Klinik für Innere Medizin/Onkologisches Zentrum
Klinik und Poliklinik für Frauenheilkunde
Brustzentrum Holweide
MVZ Onkologie
Frauenklinik Südostbayern
Klinik für Frauenheilkunde und Geburtshilfe
Franziskus-Hospital Harderberg
Brustzentrum und Gynäkologisches Krebszentrum
Department of Gynecology With Breast Center Charité-Universitätsmedizin Berlin
Department of Gynecology and Gynecologic Oncology

Research output: Contribution to journal › Original Article › peer-review

Abstract

IMPORTANCE: The increasing use of neoadjuvant systemic therapy (NST) 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 (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.

OBJECTIVE: To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.

DESIGN, SETTING, AND PARTICIPANTS: The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up.

EXPOSURE: TAD alone vs TAD with ALND.

MAIN OUTCOMES AND MEASURES: Three-year clinical outcomes were evaluated.

RESULTS: Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD 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). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74).

CONCLUSIONS AND RELEVANCE: These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.

Original language	English
Pages (from-to)	807-815
Number of pages	9
Journal	JAMA SURGERY
Volume	158
Issue number	8
DOIs	https://doi.org/10.1001/jamasurg.2023.1772
Publication status	Published - 1 Aug 2023

Keywords

Humans
Female
Middle Aged
Breast Neoplasms/surgery
Neoadjuvant Therapy/methods
Sentinel Lymph Node Biopsy/methods
Lymphatic Metastasis/pathology
Lymph Node Excision/methods
Lymph Nodes/pathology
Axilla

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10.1001/jamasurg.2023.1772

Cite this

Kuemmel, S., Heil, J., Bruzas, S., Breit, E., Schindowski, D., Harrach, H., Chiari, O., Hellerhoff, K., Bensmann, E., Hanf, V., Graßhoff, S.-T., Deuschle, P., Belke, K., Polata, S., Paepke, S., Warm, M., Meiler, J., Schindlbeck, C., Ruhwedel, W., ... Reinisch, M. (2023). Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer. JAMA SURGERY, 158(8), 807-815. https://doi.org/10.1001/jamasurg.2023.1772

@article{eef77edc2f9b414684d8f96255c8b5e4,

title = "Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer",

abstract = "IMPORTANCE: The increasing use of neoadjuvant systemic therapy (NST) 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 (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.OBJECTIVE: To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.DESIGN, SETTING, AND PARTICIPANTS: The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up.EXPOSURE: TAD alone vs TAD with ALND.MAIN OUTCOMES AND MEASURES: Three-year clinical outcomes were evaluated.RESULTS: Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5\%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4\% (95\% CI, 71.5-89.4) in the TAD with ALND group and 91.2\% (95\% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4\% (95\% CI, 0-54.8) and 1.8\% (95\% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD 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). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95\% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95\% CI, 0.15-3.83; P = .74).CONCLUSIONS AND RELEVANCE: These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.",

keywords = "Humans, Female, Middle Aged, Breast Neoplasms/surgery, Neoadjuvant Therapy/methods, Sentinel Lymph Node Biopsy/methods, Lymphatic Metastasis/pathology, Lymph Node Excision/methods, Lymph Nodes/pathology, Axilla",

author = "Sherko Kuemmel and Joerg Heil and Simona Bruzas and Elisabeth Breit and Dorothea Schindowski and Hakima Harrach and Ouafaa Chiari and Karin Hellerhoff and Elena Bensmann and Volker Hanf and Sven-Thomas Gra{\ss}hoff and Petra Deuschle and Kerstin Belke and Silke Polata and Stefan Paepke and Mathias Warm and Johannes Meiler and Christian Schindlbeck and Wencke Ruhwedel and Ulrike Beckmann and Ulrich Groh and Peter Dall and Jens-Uwe Blohmer and Alexander Traut and Mattea Reinisch",

note = "Lehr-KH: Klinikum Traunstein, Traunstein, Germany",

year = "2023",

month = aug,

day = "1",

doi = "10.1001/jamasurg.2023.1772",

language = "English",

volume = "158",

pages = "807--815",

journal = "JAMA SURGERY",

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number = "8",

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Kuemmel, S, Heil, J, Bruzas, S, Breit, E, Schindowski, D, Harrach, H, Chiari, O, Hellerhoff, K, Bensmann, E, Hanf, V, Graßhoff, S-T, Deuschle, P, Belke, K, Polata, S, Paepke, S, Warm, M, Meiler, J, Schindlbeck, C, Ruhwedel, W, Beckmann, U, Groh, U, Dall, P, Blohmer, J-U, Traut, A & Reinisch, M 2023, 'Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer', JAMA SURGERY, vol. 158, no. 8, pp. 807-815. https://doi.org/10.1001/jamasurg.2023.1772

TY - JOUR

T1 - Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

AU - Kuemmel, Sherko

AU - Heil, Joerg

AU - Bruzas, Simona

AU - Breit, Elisabeth

AU - Schindowski, Dorothea

AU - Harrach, Hakima

AU - Chiari, Ouafaa

AU - Hellerhoff, Karin

AU - Bensmann, Elena

AU - Hanf, Volker

AU - Graßhoff, Sven-Thomas

AU - Deuschle, Petra

AU - Belke, Kerstin

AU - Polata, Silke

AU - Paepke, Stefan

AU - Warm, Mathias

AU - Meiler, Johannes

AU - Schindlbeck, Christian

AU - Ruhwedel, Wencke

AU - Beckmann, Ulrike

AU - Groh, Ulrich

AU - Dall, Peter

AU - Blohmer, Jens-Uwe

AU - Traut, Alexander

AU - Reinisch, Mattea

N1 - Lehr-KH: Klinikum Traunstein, Traunstein, Germany

PY - 2023/8/1

Y1 - 2023/8/1

N2 - IMPORTANCE: The increasing use of neoadjuvant systemic therapy (NST) 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 (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.OBJECTIVE: To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.DESIGN, SETTING, AND PARTICIPANTS: The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up.EXPOSURE: TAD alone vs TAD with ALND.MAIN OUTCOMES AND MEASURES: Three-year clinical outcomes were evaluated.RESULTS: Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD 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). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74).CONCLUSIONS AND RELEVANCE: These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.

AB - IMPORTANCE: The increasing use of neoadjuvant systemic therapy (NST) 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 (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.OBJECTIVE: To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.DESIGN, SETTING, AND PARTICIPANTS: The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up.EXPOSURE: TAD alone vs TAD with ALND.MAIN OUTCOMES AND MEASURES: Three-year clinical outcomes were evaluated.RESULTS: Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD 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). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74).CONCLUSIONS AND RELEVANCE: These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.

KW - Humans

KW - Female

KW - Middle Aged

KW - Breast Neoplasms/surgery

KW - Neoadjuvant Therapy/methods

KW - Sentinel Lymph Node Biopsy/methods

KW - Lymphatic Metastasis/pathology

KW - Lymph Node Excision/methods

KW - Lymph Nodes/pathology

KW - Axilla

U2 - 10.1001/jamasurg.2023.1772

DO - 10.1001/jamasurg.2023.1772

M3 - Original Article

C2 - 37285140

SN - 2168-6254

VL - 158

SP - 807

EP - 815

JO - JAMA SURGERY

JF - JAMA SURGERY

IS - 8

ER -

Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

Abstract

Keywords

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