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.

The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC. 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. 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. 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.

Muslumanoglu M ，Cabioglu N ，Igci A ，Karanlık H ，Kocer HB ，Senol K ，Mantoglu B ，Tukenmez M ，Çakmak GK ，Ozkurt E ，Gulcelik MA ，Emiroglu S ，Mollavelioglu B ，Yildirim N ，Bademler S ，Zengel B ，Trabulus DC ，Ugurlu MU ，Uras C ，Ilgun S ，Akgul GG ，Akcan A ，Yormaz S ，Ersoy YE ，Ozbas S ，Dilege E ，Citgez B ，Bolukbasi Y ，Altınok A ，Dag A ，Basaran G ，Utkan NZ ，Ozcinar B ，Arici C ，AlJorani I ，Kara H ，Yigit B ，Sen E ，Erozgen F ，Soyder A ，Celik B ，Kilic HG ，Zer L ，Sakman G ，Yeniay L ，Atahan K ，Varol E ，Veliyeva V ，Goktepe B ，Velidedeoglu M ，Karaman N ，Soran A ，Aydiner A ，Yılmaz R ，Ibis K ，Ozmen V ... -  《-》

De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer.

Cabioglu N ，Koçer HB ，Karanlik H ，Gülçelik MA ，Igci A ，Müslümanoglu M ，Uras C ，Mantoglu B ，Trabulus DC ，Akgül G ，Tükenmez M ，Senol K ，Özkurt E ，Sen E ，Karadeniz Çakmak G ，Bademler S ，Emiroglu S ，Yildirim N ，Kara H ，Dag A ，Dilege E ，Altinok A ，Basaran G ，Varol E ，Ugurlu Ü ，Bölükbasi Y ，Ersoy YE ，Zengel B ，Karaman N ，Özbas S ，Zer L ，Gül Kiliç H ，Agcaoglu O ，Sakman G ，Utkan Z ，Soyder A ，Akcan A ，Ergün S ，Yilmaz R ，Aydiner A ，Soran A ，Ibis K ，Özmen V ... -  《-》

Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03.

This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

Cabioglu N ，Karanlik H ，Igci A ，Muslumanoglu M ，Gulcelik MA ，Uras C ，Kocer HB ，Trabulus DC ，Ozkurt E ，Cakmak GK ，Tukenmez M ，Bademler S ，Yildirim N ，Akgul GG ，Sen E ，Senol K ，Emiroglu S ，Citgez B ，Ersoy YE ，Dag A ，Zengel B ，Basaran G ，Kara H ，Dilege E ，Ugurlu MU ，Celik A ，Ilgun S ，Bolukbasi Y ，Karaman N ，Sakman G ，Ozbas S ，Kilic HG ，Polat AK ，Ozemir IA ，Kilic B ，Altınok A ，Varol E ，Dogan L ，Akcan A ，Ozcinar B ，Zer L ，Soyder A ，Velidedeoglu M ，Erozgen F ，Goktepe B ，Dogan M ，Kebudi A ，Yigit B ，Celik B ，Yormaz S ，Arici C ，Agcaoglu O ，Sevinc AI ，Atahan MK ，Valiyeva V ，Baran E ，Aljorani I ，Utkan Z ，Yeniay L ，Kivilcim T ，Soran A ，Aydiner A ，Ibis K ，Ozmen V ... -  《-》

Axillary Lymph Node Dissection versus Loco-regional Radiotherapy in Management of the Axilla in Node-Negative Locally Advanced Breast Cancer Post Neoadjuvant Chemotherapy.

Background: The evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: Sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: No Statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC for patient who have shown down-staging of their axillary status after NACT. Radiotherapy can show better results in the long term with regards lymphedema.

Ebrahim AK ，Lasheen O ，Mokhtar S ，Lasheen S ，Hassan M ，Khallaf E ... -  《Chirurgia》

Axillary Lymph Node Dissection versus Loco-regional Radiotherapy in Management of the Axilla in Node-Negative Locally Advanced Breast Cancer Post Neoadjuvant Chemotherapy.

Background: the evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. Objective: To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: no statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Conclusion: axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC.

Ebrahim AK ，Lasheen O ，Mokhtar S ，Lasheen S ，Hassan M ，Khallaf E ... -  《Chirurgia》