Contemporary Trends in Axillary Surgery for ER-Positive, HER2-Negative Breast Cancer Stratified by Neoadjuvant Endocrine Therapy, Neoadjuvant Chemotherapy, or Upfront Surgery

作者：Sasha Douglas, Samantha M. Thomas, Akiko Chiba, Maggie L. DiNome, Gayle DiLalla, E. Shelley Hwang, Kendra Modell Parrish, Laura H. Rosenberger, Jennifer K. Plichta, Ton Wang, Astrid M Botty van den Bruele · 发表于：Annals of Surgical Oncology · 年份：2025 · DOI：10.1245/s10434-025-18225-5 · 被引用次数：4 · 研究领域：Breast Cancer Treatment Studies、Breast Implant and Reconstruction、Breast Lesions and Carcinomas

BACKGROUND: De-escalation of axillary surgery for hormone receptor-positive breast cancer has gained traction, but guidelines for axillary management after neoadjuvant endocrine therapy (NET) remain ill-defined. METHODS: Female patients age ≥50 years with clinical T1-4c, N0-1, ER+/HER2- breast cancer (2012-2021) were selected from the National Cancer Database (NCDB) and divided into three groups based on treatment: upfront surgery, neoadjuvant chemotherapy (NAC), or NET. Axillary surgery was categorized as no axillary surgery, sentinel lymph node biopsy (SLNB) alone, sentinel lymph node biopsy followed by axillary lymph node dissection (ALND), or ALND alone. Descriptive analysis and logistic regression were used to identify factors associated with ALND, and survival analysis was performed. RESULTS: The inclusion criteria were met by 792,581 patients. The majority underwent surgery first (94.3 %), whereas 2.6 % received NAC and 3.1 % received NET. After adjustment, the odds of undergoing ALND were shown to be higher for those receiving NAC (odds ratio [OR], 1.18; 95 % confidence interval [CI], 1.12-1.24) or NET (OR, 1.10; 95 % CI, 1.05-1.14) than for those receiving surgery first (p < 0.001). The patients receiving NET were less likely to convert from cN+ to ypN0 (8.3 % vs NAC 19.6 %; p < 0.001), but they still were less likely to undergo ALND after SLNB. Overall survival was highest among the patients in the surgery-first group regardless of clinical nodal status (p < 0.001)...