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However, the benefit of ALND in patients with 3\u20135 positive LNs remains debated. We examined national trends of ALND versus SLNB in this subgroup and evaluated survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Using the National Cancer Database, we identified patients with pT0\u20132 ER+\/HER2\u2212 breast cancer with 3\u20135 positive LNs who underwent adjuvant chemotherapy, endocrine therapy, and radiation therapy from January 2012 to December 2020. We compared patients who had SLNB alone versus ALND \u00b1 SLNB<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 13,270 patients, 1712 (12.9%) had SLNB and 11,558 (87.1%) had ALND. ALND rates decreased by 18.3% during the study period (93.4% to 75.1%). Compared with ALND, SLNB group had higher proportion of three positive LNs (63.1% versus 43.1%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), Charlson Comorbidity Index 0 (87.4% versus 84.4%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), pT1 tumor (42.8% versus 35.4%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), well-to-moderately differentiated tumor (72% versus 66.9%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), absence of lymphovascular invasion (42.7% versus 36.3%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), and lobular histology (16.5% versus 12.7%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). There was no difference in overall survival (OS) between SLNB and ALND in univariate or multivariable models (adjusted HR 1.0,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.77).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>National rates for ALND decreased in patients with 3\u20135 positive LNs over the last decade. There was no difference in OS with omission of ALND in patients with ER+\/HER2\u2212 breast cancer with 3\u20135 positive LNs, supporting further studies to evaluate deescalation of axillary surgery in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-025-18546-5","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T18:03:04Z","timestamp":1761328984000},"page":"1189-1200","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Omission of Axillary Lymph Node Dissection in Patients with pT0-2 ER+\/HER2\u2212 Breast Cancer with 3\u20135 Positive Lymph Nodes Undergoing Adjuvant Systemic Therapy and Radiation Does Not Impact Overall Survival: A National Cancer Database Analysis"],"prefix":"10.1245","volume":"33","author":[{"given":"Annie","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Farmah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Schulz-Costello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Bazan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Rand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"issue":"10","key":"18546_CR1","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/S1470-2045(10)70207-2","volume":"11","author":"DN Krag","year":"2010","unstructured":"Krag DN, Anderson SJ, Julian TB, et al. 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