{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:23:24Z","timestamp":1781843004385,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:00:00Z","timestamp":1608163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Most breast cancer (BC) patients present with early disease and clinically negative lymph nodes (cN0). Timing of surgery has not been standardized. We hypothesized that surgical delay results in an increased likelihood of nodal metastasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with cN0 BC undergoing surgery with sentinel lymph node biopsy as initial therapy between 2006 and 2014 were identified in the NCDB and divided into four groups based on time intervals between diagnosis and surgery (&lt;4 weeks, 4\u20138 weeks, 8\u201312 weeks, and\u2009&gt;12 weeks). Regression analysis evaluated the independent impact of surgical timing on axillary upstaging and survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 355,443 patients with cN0 BC, 39.6% had surgery within 4 weeks and 5.4%\u2009more than\u200912 weeks from diagnosis. After controlling for relevant factors, a month delay in surgery was associated with an increased likelihood of nodal positivity (odds ratio: 1.04; 95% confidence interval [CI]: 1.04\u20131.05; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and decreased overall survival (hazard ratio: 1.03; 95% CI: 1.02\u20131.04; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). When compared to patients who underwent surgery\u2009less than 4 weeks from diagnosis, the absolute increase in nodal positivity and relative risks were 5.3% (95% CI: 0.047\u20130.059) and 1.34 (95% CI: 1.30\u20131.38), respectively, in the\u2009more than 12 weeks group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Delay in BC surgery in cN0 patients was associated with an increased likelihood of axillary upstaging and decreased survival.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.26332","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T14:00:04Z","timestamp":1608300004000},"page":"854-865","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Delay in surgery is associated with axillary upstaging of clinically node negative breast cancer patients"],"prefix":"10.1002","volume":"123","author":[{"given":"Adam","family":"Khader","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu\u2010Ching","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Medical Data Research Center at Providence Health and Services Center  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Santamaria\u2010Barria","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Garland\u2010Kledzik","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Scholer","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janie","family":"Grumley","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-7924","authenticated-orcid":false,"given":"Trevan","family":"Fischer","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology John Wayne Cancer Institute at Providence Saint John's Health Center  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21551"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-14-1286"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.4508"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5486-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6615-2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4397-3"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.07.276"},{"key":"e_1_2_9_9_1","unstructured":"GradisharWJ AbrahamJ AftR et al.NCCN Guidelines Version 3.2019 Breast Cancer NCCN Evidence Blocks TM NCCN Guidelines.; 2019. 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