The Impact of the Volume of Surgical Treatment in Axillary Zones in Patients with Early-Stage Breast Cancer (cT1-2N0-1)

Axillary lymphadenectomy (ALA) has always been a component of surgical treatment for breast cancer (BC) [1]. Two major randomized clinical trials (RCTs) did not show any advantage in overall survival (OS) and progression-free survival (PFS) when comparing more extensive versus less extensive surgical treatment in patients with clinically non-metastatic lymph nodes (cN0) [2, 3]. In the 1990s, sentinel lymph node biopsy (SLNB) was incorporated into the algorithm for the surgical treatment of breast cancer [4]. Several prospective RCTs comparing these two surgical methods demonstrated equivalent regional control, PFS, and OS [5–8]. However, a personalized approach to the surgical treatment of breast cancer patients with one or two metastases in sentinel lymph nodes (SLN) is still lacking. Recent retrospective studies have shown that ALA does not improve survival outcomes after mastectomy in patients with positive SLNs [15–17]. Moreover, in everyday clinical practice, the use of lymphadenectomy in these patients has been steadily declining [18]. To expand recommendations for omitting ALA, we present an analysis of 524 patients.

Objective. To assess the impact of sentinel lymph node biopsy and lymphadenectomy on survival outcomes in patients with primary operable breast cancer (T0-2N0/N0-1). 

Methods. This retrospective study included 524 women with ductal/lobular breast cancer of stage I – IIB. Depending on the volume of surgical intervention in the lymphatic collector, patients were divided into the following groups: Group I, where sentinel lymph node biopsy was performed in 111 (21.2%) patients; Group II, where axillary lymph node dissection was performed in 413 (78.8%) patients (of which 280 patients had previous sentinel lymph node biopsy).

Results. The median follow-up time for the patients was 61.3 ± 22.8 months (ranging from 18.1 to 140 months, with a median of 57.7 months). The median age was 51 [42.0;61.0] years. According to the clinical stage by TNM, the distribution of patients was as follows: T1N0M0 (n=277), T2N0M0 (n=213), T1N1M0 (n=3), T2N1M0 (n=31). Neoadjuvant chemotherapy was given to 26.2% (n=137) of patients. The frequency of neoadjuvant chemotherapy significantly increased with the clinical stage, from 2.2% (n=6) in T1N0 to 100% (n=31) in T2N1 (p=0.00001). Surgical treatment consisted of sectoral resection in 50.6% (n=265) and radical mastectomy in 49.4% (n=259). Death occurred in 2.7% (n=14) of patients, and progression was detected in 6.9% (n=36). The 5-year PFS and OS rates in Groups I and II did not differ significantly, being 98.2 ± 1.3%, 92.93 ± 1.6% and 100%, 97.9 ± 0.9%, respectively. The median OS and PFS were not reached.

Conclusion. In patients with T0-2N0/N0-1 breast cancer who underwent lymphadenectomy, overall survival and progression-free survival were not inferior to those who underwent sentinel lymph node biopsy.