{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:09:23Z","timestamp":1793650163755,"version":"4.5.1"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec id=\"ab-soi240095-4\"><jats:title>Importance<\/jats:title><jats:p>Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)\u2013positive breast cancer and patients whose disease became cN negative after NAC (ycN negative).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-7\"><jats:title>Exposure<\/jats:title><jats:p>Treatment with SLNB or TAD after NAC.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-9\"><jats:title>Results<\/jats:title><jats:p>A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n\u2009=\u2009620) or TAD alone (n\u2009=\u2009356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n\u2009=\u2009177) or without (n\u2009=\u2009468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; <jats:italic>P<\/jats:italic>\u2009=\u2009.09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; <jats:italic>P<\/jats:italic>\u2009\u2265\u2009.99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; <jats:italic>P<\/jats:italic>\u2009=\u2009.50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; <jats:italic>P<\/jats:italic>\u2009=\u2009.07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; <jats:italic>P<\/jats:italic>\u2009=\u2009.03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; <jats:italic>P<\/jats:italic>\u2009=\u2009.007).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240095-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.5913","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T16:01:09Z","timestamp":1735833669000},"page":"257","source":"Crossref","is-referenced-by-count":34,"title":["De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer"],"prefix":"10.1001","volume":"160","author":[{"given":"Neslihan","family":"Cab\u0131o\u011flu","sequence":"first","affiliation":[{"name":"Breast Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Havva Belma","family":"Ko\u00e7er","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, 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