{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:08:25Z","timestamp":1785330505066,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Trials show that sentinel lymph node biopsy (SLNB) can replace completion axillary lymph node dissection (ALND) for selected cN0 patients without compromising survival but real-world evidence from non-Western settings especially on regional nodal control remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 53,758 female patients with cN0, pT1-3, pN0\u20131 breast cancer from the National Cancer Center Oncology Information Database (2013-2022). For pN1, survival analyses were restricted to 2017-2022. Propensity score matching and competing-risks models were employed to compare overall survival, breast cancer specific survival, and regional nodal recurrence (RNR) between SLNB and ALND.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SLNB use increased from 18.8% to 75.3% in pN0 and from 9.7% to 48.2% in pN1. In pN0, 5-year RNR was similar for SLNB versus ALND (1.06% vs 0.96%; adjusted SHR 1.03). In pN1, SLNB was associated with higher 5-year RNR after breast-conserving surgery (BCS) (4.99% vs 1.27%; adjusted SHR 4.44; P\u00a0=\u00a00.033), most pronounced for Ki-67 \u226530% (SHR 12.79; P\u00a0=\u00a00.012) and no special type histology (SHR 5.90; P\u00a0=\u00a00.017). In the mastectomy cohort, 5-year RNR did not differ between SLNB and ALND (3.01% vs 2.05%; P\u00a0=\u00a00.946; adjusted SHR 1.22), except among patients without endocrine therapy (SHR 6.28; P\u00a0=\u00a00.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Axillary de-escalation has been widely adopted in China and appears oncologically safe for patients with pN0 disease and for those with pN1 disease undergoing mastectomy. In contrast, among patients with pN1 disease treated with breast-conserving surgery, SLNB was associated with a higher risk of regional nodal recurrence. When ALND is omitted, guideline-concordant adjuvant management may be important to maintain regional control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1809288","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:51:38Z","timestamp":1782276698000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends, survival and regional control of sentinel lymph node biopsy versus axillary dissection in cN0 breast cancer: a multicenter cohort in China"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiang","family":"Wu","sequence":"first","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, 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