Oncological outcomes of sentinel lymph node biopsy alone in patients with residual nodal disease after neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis.

BACKGROUND

The optimum axillary management of patients with node-positive breast cancer who have residual nodal disease (ypN+) following neoadjuvant chemotherapy (NAC) remains unclear. The aim of this systematic review was to evaluate oncological outcomes of patients with ypN + disease treated with sentinel lymph node biopsy (SLNB) only.

METHODS

Three major databases (PubMed, EMBASE and Scopus) were searched. The primary endpoint was 5-year overall survival. Secondary outcomes included axillary recurrence and distant recurrence rates. Only studies reporting at least one endpoint were included. Overall survival data were expressed as dichotomous variables and pooled as odds ratios using the Mantel-Haenszel method. Trial Sequential Analysis was also performed.

RESULTS

The final data set consisted of 9 retrospective studies, including 9889 patients. Five studies reported 5-year overall survival, 5 reported axillary recurrence rates and 4 reported rates of distant metastases. Median follow-up was 45 months (2.5-182.5). The overall weighted mean 5-year overall survival for patients undergoing SLNB alone was 85.2 % (71-93). Omission of axillary lymph node dissection (ALND) was not associated with any difference in overall survival (OR 0.90, 95 % CI 0.64-1.26, p = 0.54) or rate of axillary recurrence at 5 years (OR 1.08, 0.64-1.83, P = 0.77).

CONCLUSION

Omission of ALND is not associated with inferior long-term oncological outcomes in patients with a positive sentinel lymph node biopsy after NAC. Although further prospective evidence is required, it is likely that select patients with limited nodal positivity after NAC could avoid ALND and its associated morbidity.