{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:25Z","timestamp":1753891885223,"version":"3.41.2"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Axillary management of patients with early-stage breast cancer (ESBC) has evolved, especially with the implementation of precision radiotherapy techniques that have resulted in a significant reduction in treatment-related toxicities, but it is unclear whether post-mastectomy radiotherapy (PMRT) improves survival outcomes in breast cancer with lymph nodes micrometastases (BCLNMM, that is T0, T1 ~2NmiM0). Our study is to systematically evaluate the effect of PMRT on survival in breast cancer with lymph nodes micrometastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was performed for randomized controlled trials (RCTs) or retrospective studies related to PMRT versus non-post-mastectomy radiotherapy (non-PMRT) in the adjuvant treatment of ESBC in PubMed, Cochrane Library, Embase, CNKI and other databases. R package <jats:italic>meta<\/jats:italic> software was used to perform meta-analyses with hazard ratio (HR). Newcastle Ottawa scale was selected for quality assessment. The review was prospectively registered on PROSPERO (CRD42024562444).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>10 relevant studies were screened, all of which were retrospective studies. The difference in overall survival (OS) was not statistically significant (HR = 0.92, 95%CI: 0.81 ~ 1.04; Z = 1.35, <jats:italic>P<\/jats:italic> = 0.177). The difference in breast cancer-specific survival (BCSS) between the PMRT group and the non-PMRT group was not statistically significant HR = 1.18, 95%CI: 0.94 ~ 1.48; Z = 1.41, <jats:italic>P<\/jats:italic> =0.160). The difference in disease-free survival (DFS) was statistically significant (HR = 0.47, 95%CI: 0.23 ~ 1.00; Z = 1.96, <jats:italic>P<\/jats:italic> =0.049). The difference in local recurrence free survival (LRRFS) was also not statistically significant (HR = 0.50, 95%CI: 0.11 ~ 2.26, <jats:italic>P<\/jats:italic> = 0.190). The difference in distant-metastasis free survival (DMFS) was not statistically significant (HR = 0.54, 95%CI: 0.22 ~ 1.35, <jats:italic>P<\/jats:italic> = 0.356).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the tendency of PMRT in BCLNMM to improve DFS, OS, BCSS, LRRFS, and DMFS showed no benefit, therefore, PMRT should be used with caution in BCLNMM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:uri>, identifier CRD42024562444.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1489390","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T04:13:00Z","timestamp":1746677580000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of post-mastectomy radiation therapy on survival in breast cancer with lymph nodes micrometastases: a meta-analysis and systematic review"],"prefix":"10.3389","volume":"15","author":[{"given":"Jianqing","family":"Zheng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bifen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhangzhu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13174287","article-title":"Breast cancer-epidemiology, risk factors, classification, prognostic markers, and current treatment strategies-an updated review","volume":"13","author":"\u0141ukasiewicz","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20211033","article-title":"Understanding breast cancer as a global health concern","volume":"95","author":"Wilkinson","year":"2022","journal-title":"Br J Radiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/cm9.0000000000001474","article-title":"Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020","volume":"134","author":"Cao","year":"2021","journal-title":"Chin Med J (Engl)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/cm9.0000000000002108","article-title":"Cancer statistics in China and United States, 2022: profiles, trends, and determinants","volume":"135","author":"Xia","year":"2022","journal-title":"Chin Med J (Engl)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2022.115209","article-title":"Targeted therapy for breast cancer: An overview of drug classes and outcomes","volume":"204","author":"Jacobs","year":"2022","journal-title":"Biochem Pharmacol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6486-6","article-title":"Eighth edition of the AJCC cancer staging manual: breast cancer","volume":"25","author":"Giuliano","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-015-1168-5","article-title":"Clinical significance of breast cancer micrometastasis in the sentinel lymph node","volume":"46","author":"Shimazu","year":"2016","journal-title":"Surg Today"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2021.12.015","article-title":"Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis","volume":"164","author":"Guani","year":"2022","journal-title":"Gynecol Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-021-06162-2","article-title":"Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases","volume":"187","author":"Hetterich","year":"2021","journal-title":"Breast Cancer Res Treat"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2019.05.013","article-title":"Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes","volume":"46","author":"Mok","year":"2019","journal-title":"Breast"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1012646","article-title":"The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer: A competing risk analysis using the SEER database","volume":"12","author":"Zhou","year":"2022","journal-title":"Front Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab141","article-title":"Omitting completion axillary lymph node dissection after detection of sentinel node micrometastases in breast cancer: first results from the prospective SENOMIC trial","volume":"108","author":"Andersson","year":"2021","journal-title":"Br J Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.21037\/tcr-23-1639","article-title":"An exploratory study of whether axillary lymph node dissection can be avoided in breast cancer patients with positive lymph nodes","volume":"13","author":"Ren","year":"2024","journal-title":"Transl Cancer Res"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-019-04977-1","article-title":"Sentinel lymph node biopsy in early breast cancer: magnetic tracer as the only localizing agent","volume":"43","author":"Man","year":"2019","journal-title":"World J Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1186\/s12957-023-03082-x","article-title":"Prognosis and local treatment strategies of breast cancer patients with different numbers of micrometastatic lymph nodes","volume":"21","author":"Luo","year":"2023","journal-title":"World J Surg Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"9056","DOI":"10.1038\/s41598-021-88442-x","article-title":"Sentinel node biopsy alone for breast cancer patients with residual nodal disease after neoadjuvant chemotherapy","volume":"11","author":"Chun","year":"2021","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1080\/14737140.2019.1660165","article-title":"Controversies in locoregional management of breast cancer with low volume pN0(i+) and pN1mi nodal disease","volume":"19","author":"Dosani","year":"2019","journal-title":"Expert Rev Anticancer Ther"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1184021","article-title":"Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinel nodes after neoadjuvant therapy (ADARNAT trial)","volume":"13","author":"Garcia-Tejedor","year":"2023","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.01565","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981\u201322023 AMAROS trial","volume":"41","author":"Bartels","year":"2023","journal-title":"J Clin Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8","article-title":"Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints","volume":"17","author":"Parmar","year":"1998","journal-title":"Stat Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e1259","DOI":"10.1097\/md.0000000000001259","article-title":"Do recent advances in diagnostic and therapeutic procedures negate the benefit of postmastectomy radiotherapy in N1 patients with a low risk of locoregional recurrence","volume":"94","author":"Chang","year":"2015","journal-title":"Med (Baltimore)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(18)31055-7","article-title":"Postmastectomy radiation leads to increased mortality in patient with nodal micrometastasis","volume":"127","author":"Eastwick","year":"2018","journal-title":"Radiother Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-018-4840-9","article-title":"Extent of regional lymph node surgery and impact on outcomes in patients with early-stage breast cancer and limited axillary disease undergoing mastectomy","volume":"171","author":"Picado","year":"2018","journal-title":"Breast Cancer Res Treat"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6632-1","article-title":"Post-mastectomy radiation therapy in breast cancer patients with nodal micrometastases","volume":"25","author":"Wu","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00270","article-title":"21-gene recurrence score assay could not predict benefit of post-mastectomy radiotherapy in T1\u20132 N1mic ER-positive HER2-negative breast cancer","volume":"9","author":"Zhang","year":"2019","journal-title":"Front Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2020.02.009","article-title":"The effect of post mastectomy radiation therapy on survival in breast cancer patients with N1mic disease","volume":"51","author":"Patel","year":"2020","journal-title":"Breast"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.570175","article-title":"Prognostic and predictive value of the american joint committee on cancer pathological prognostic staging system in nodal micrometastatic breast cancer","volume":"10","author":"Shi","year":"2020","journal-title":"Front Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-021-06341-1","article-title":"Outcomes of stage I and II breast cancer with nodal micrometastases treated with mastectomy without axillary therapy","volume":"189","author":"Lim","year":"2021","journal-title":"Breast Cancer Res Treat"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e933275","DOI":"10.12659\/msm.933275","article-title":"Impact of post-mastectomy radiation therapy for sentinel lymph node micrometastases in early-stage breast cancer patients","volume":"28","author":"Luo","year":"2022","journal-title":"Med Sci Monit"},{"key":"B34","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.path.2021.11.002","article-title":"Pathologic evaluation of lymph nodes in breast cancer: contemporary approaches and clinical implications","volume":"15","author":"Balla","year":"2022","journal-title":"Surg Pathol Clin"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s12282-019-01020-y","article-title":"Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection","volume":"27","author":"Akezaki","year":"2020","journal-title":"Breast Cancer"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2012.07.012","article-title":"Clinical significance and management of sentinel node micrometastasis in invasive breast cancer","volume":"12","author":"Jafferbhoy","year":"2012","journal-title":"Clin Breast Cancer"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1097\/cco.0000000000000789","article-title":"Postmastectomy radiotherapy: a review","volume":"33","author":"Kunkler","year":"2021","journal-title":"Curr Opin Oncol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-012-0083-6","article-title":"Postoperative periclavicular radiotherapy in breast cancer patients with 1\u20133 positive axillary lymph nodes. Outcome and morbidity","volume":"188","author":"Biancosino","year":"2012","journal-title":"Strahlenther Onkol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(18)30380-2","article-title":"Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial","volume":"19","author":"Galimberti","year":"2018","journal-title":"Lancet Oncol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90","article-title":"Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial","volume":"305","author":"Giuliano","year":"2011","journal-title":"JAMA"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-012-2569-y","article-title":"Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048\/13\/2000","volume":"20","author":"Sol\u00e1","year":"2013","journal-title":"Ann Surg Oncol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(11)61629-2","article-title":"Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials","volume":"378","author":"Darby","year":"2011","journal-title":"Lancet"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2022.100043","article-title":"Cost-effectiveness of Post-Mastectomy Radiotherapy (PMRT) for breast cancer in India: An economic modelling study","volume":"4","author":"Gupta","year":"2022","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"B44","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/s1470-2045(17)30777-5","article-title":"Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials","volume":"19","year":"2018","journal-title":"Lancet Oncol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2018.03.010","article-title":"The evolving role of postmastectomy radiation therapy","volume":"98","author":"Everett","year":"2018","journal-title":"Surg Clin North Am"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5605-5","article-title":"Outcomes of sentinel lymph node-positive breast cancer patients treated with mastectomy without axillary therapy","volume":"24","author":"FitzSullivan","year":"2017","journal-title":"Ann Surg Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1489390\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T04:13:01Z","timestamp":1746677581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1489390\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":46,"alternative-id":["10.3389\/fonc.2025.1489390"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1489390","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2025,5,8]]},"article-number":"1489390"}}