{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:48:18Z","timestamp":1785912498117,"version":"3.56.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec id=\"ab-soi230044-4\"><jats:title>Importance<\/jats:title><jats:p>The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)\u2013positive breast cancer (BC) is currently unknown.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230044-5\"><jats:title>Objective<\/jats:title><jats:p>To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230044-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03\/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230044-7\"><jats:title>Exposures<\/jats:title><jats:p>All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230044-8\"><jats:title>Results<\/jats:title><jats:p>A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)\u2013positive and Erb-B2 receptor tyrosine kinase 2 (<jats:italic>ERBB2<\/jats:italic>; formerly <jats:italic>HER2<\/jats:italic> or <jats:italic>HER2\/neu<\/jats:italic>)\u2013negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine\u2013DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230044-9\"><jats:title>Conclusion<\/jats:title><jats:p>Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2023.2840","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T15:09:38Z","timestamp":1689779378000},"page":"1013","source":"Crossref","is-referenced-by-count":24,"title":["Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer"],"prefix":"10.1001","volume":"158","author":[{"given":"Walter P.","family":"Weber","sequence":"first","affiliation":[{"name":"Breast Center, University Hospital Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoltan","family":"Matrai","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Dept of Oncoplastic Breast Surgery, Doha, 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