Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study
Neslihan Cabioglu, Mahmut Muslumanoglu, Mustafa Tukenmez, Selman Emiroglu, Vahit Ozmen, Abdullah Igci, Hasan Karanlik, Nilufer Yildirim, G. Cakmak Karadeniz, D. Trabulus Can, Yeliz E. Ersoy, Cihan Uras, Halil Kara, B. Zengel, Ayfer Kamali Polat, Levent Yeniay, Enver Ozkurt, Kamuran Ibis, Adnan Aydiner
article (Uluslararası, Hakemli) | Yazar(lar): Neslihan Cabioglu, Mahmut Muslumanoglu, Mustafa Tukenmez, Selman Emiroglu, Vahit Ozmen, Abdullah Igci, Hasan Karanlik, Nilufer Yildirim, G. Cakmak Karadeniz, D. Trabulus Can, Yeliz E. Ersoy, Cihan Uras, Halil Kara, B. Zengel, Ayfer Kamali Polat, Levent Yeniay, Enver Ozkurt,
Purpose: Factors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC). Methods: Between 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation. Results: Median age was 46 (23-70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 pa-tients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24-172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14-5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16-5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89-5.01) were found to have an increased HR compared to others in 5-year DFS. However, no dif-ference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44-3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63-5.79). Conclusion: ALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pa-thology, as long as axillary radiotherapy is provided. (c) 2021 Published by Elsevier Ltd.