Combined analysis of the MF18-02/MF18-03 NEOSENTITURK studies: ypN-positive disease does not necessitate axillary lymph node dissection in patients with breast cancer with a good response to neoadjuvant chemotherapy as long as radiotherapy is provided.
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Muslumanoglu Mahmut, Cabioglu Neslihan, Igci Abdullah, Karanlık Hasan, Kocer Havva Belma, Senol Kazim, Mantoglu Baris, Tukenmez Mustafa, Çakmak Guldeniz Karadeniz, Ozkurt Enver, Gulcelik Mehmet Ali, Emiroglu Selman, Mollavelioglu Baran, Yildirim Nilufer, Bademler Suleyman, Zengel Baha, Trabulus Didem Can, Ugurlu Mustafa Umit, Uras Cihan, Ilgun Serkan, Akgul Gokhan Giray, Akcan Alper, Yormaz Serdar, Ersoy Yeliz Emine, Ozbas Serdar, Dilege Ece, Citgez Bulent, Bolukbasi Yasemin, Altınok Ayse, Dag Ahmet, Basaran Gül, Utkan Nihat Zafer, Ozcinar Beyza, Arici Cumhur, AlJorani Israa, Kara Halil, Yigit Banu, Sen Ebru, Erozgen Fazilet, Soyder Aykut, Celik Burak, Kilic Halime Gul, Zer Leyla, Sakman Gürhan, Yeniay Levent, Atahan Kemal, Varol Ecenur, Veliyeva Vefa, Goktepe Berk, Velidedeoglu Mehmet, Karaman Niyazi, Soran Atilla, Aydiner Adnan, Yılmaz Ravza, Ibis Kamuran, Ozmen Vahit
Аннотация
METHODS: A joint analysis of two different multicenter cohorts-the retrospective cohort registry MF18-02 and the prospective observational cohort registry MF18-03 (NCT04250129)-was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.
RESULTS: Five hundred and one patients with cT1-4, N1-3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow-up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease-free survival (DFS) and disease-specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.
CONCLUSIONS: The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.