De-escalation of axillary surgery after neoadjuvant therapy in breast cancer: long-term outcomes of sentinel lymph node biopsy alone versus complete axillary lymph node dissection

作者：Haizhu Chen, Xiaoyan Qian, Luhui Mao, Yunxia Tao, Yaping Yang, Xiujuan Gui, Qiang Liu, Herui Yao · 发表于：Therapeutic Advances in Medical Oncology · 年份：2026 · DOI：10.1177/17588359251405095 · 被引用次数：1 · 研究领域：Breast Cancer Treatment Studies、Breast Implant and Reconstruction、Breast Lesions and Carcinomas

Background: The optimal management of axillary lymph nodes after neoadjuvant systemic therapy (NST) in breast cancer remains controversial. The oncological outcomes of sentinel lymph node biopsy (SLNB) alone compared with axillary lymph node dissection (ALND) after NST are not well established. Objective: This study comprehensively evaluated the long-term outcomes of SLNB alone versus ALND following NST in breast cancer patients achieving ycN0 status. Design: A retrospective, multicenter, real-world study. Methods: Patients initially presenting with clinically node-negative (cN0) or clinically node-positive (cN+) breast cancer who remained or converted to ycN0 after NST (2011-2022) were included. Patients were divided into SLNB-alone and ALND groups. Primary endpoints were disease-free survival (DFS) and overall survival (OS). Secondary endpoints included recurrence rates, local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Results: = 0.059). No significant differences in DFS, OS, LRFS, RRFS, or DMFS were observed between the SLNB-alone and ALND groups after IPTW adjustment. Subgroup analyses confirmed similar DFS or OS between the two surgical approaches across initial cN0 and cN+ subgroups; however, patients with initial cN2-3 disease exhibited inferior LRFS with SLNB alone. Conclusion: SLNB alone achiev...