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This paper reports cALND rates in the clinical routine for patients who had higher (T3\u2013T4) tumor stages and\/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3\u2013T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Data were available for 188,909 patients, of whom 19,009 were identified with 1\u20132 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1\u2013T2 tumors receiving BCT (ACOSOG Z0011 eligible; <jats:italic>n<\/jats:italic>\u2009=\u200913,741), (2) T1\u2013T2 with mastectomy (<jats:italic>n<\/jats:italic>\u2009=\u20094093), (3) T3\u2013T4 with BCT (<jats:italic>n<\/jats:italic>\u2009=\u2009269), (4) T3\u2013T4 with mastectomy (<jats:italic>n<\/jats:italic>\u2009=\u2009906). Among patients with T3\u2013T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1\u20134 were 33.4%, 42.3%, 46.9%, 58.8%, respectively.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The cALND rates have decreased substantially in routine care in patients with \u2018extended\u2019 ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s10549-020-05876-z","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T09:04:01Z","timestamp":1597914241000},"page":"627-636","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Analyzing non-sentinel axillary metastases in patients with T3\u2013T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy"],"prefix":"10.1007","volume":"184","author":[{"given":"Fabian","family":"Riedel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joerg","family":"Heil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Feisst","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mareike","family":"Moderow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"von Au","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Domschke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Michel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Schaefgen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Golatta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7998-3796","authenticated-orcid":false,"given":"Andr\u00e9","family":"Hennigs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"issue":"4","key":"5876_CR1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1056\/NEJMoa1415340","volume":"373","author":"TJ Whelan","year":"2015","unstructured":"Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A et al (2015) Regional nodal irradiation in early-stage breast cancer. 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Joerg Heil declares he has no conflict of interest. Mareike Moderow declares she has no conflict of interest. Manuel Feisst declares he has no conflict of interest. Alexandra von Au declares she has no conflict of interest. Christoph Domschke declares he has no conflict of interest. Laura Michel declares she has no conflict of interest. Benedikt Schaefgen declares he has no conflict of interest. Michael Golatta declares he has no conflict of interest. Andr\u00e9 Hennigs declares he has no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of the University of Heidelberg.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The study was deemed to be without risk, including only analysis of anonymized, routinely collected data; consequently, the ethics committee of the University of Heidelberg did not request approval for patient consent for this designated analysis. Informed consent was obtained from all individual participants for the data acquisition of the benchmarking process.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}