{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T14:49:00Z","timestamp":1785163740422,"version":"3.55.0"},"reference-count":13,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fujian Provincial Science and Technology Innovation Joint Funding Project, China","award":["2025Y9500"],"award-info":[{"award-number":["2025Y9500"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The optimal management of patients with limited sentinel lymph node metastasis in breast cancer, particularly regarding whether to perform additional axillary surgery, continues to be an area of clinical uncertainty in routine practice. This multicenter retrospective cohort study aimed to evaluate adherence to ACOSOG Z0011 criteria and the oncological safety of omitting ALND in a Chinese population. We included 462 women with clinical stage T1\u20132N0 breast cancer who underwent breast-conserving surgery and were found to have 1\u20132 positive SLNs between January 2013 and December 2021. All patients received adjuvant radiotherapy and systemic therapy. Patients underwent either sentinel lymph node biopsy alone (SLNB; n = 274, 59.3%) or SLNB followed by ALND (n = 188, 40.7%). Propensity score matching (1:1) was applied to balance baseline characteristics, yielding 152 matched pairs. Disease-free survival (DFS) was the primary endpoint. No significant difference in DFS was observed between the SLNB alone and SLNB + ALND groups in either the overall cohort or the matched cohort. Multivariable Cox regression analysis confirmed that the type of axillary surgery was not independently associated with DFS in patients with 1\u20132 positive SLNs treated with breast-conserving surgery. Logistic regression analysis indicated that surgeons were more likely to perform ALND in patients with a higher SLN tumor burden; compared with micrometastasis, macrometastasis in 1\u20132 SLNs and a sentinel lymph node metastasis ratio greater than one-third were significantly associated with the selection of ALND. These findings suggest that omission of ALND was not associated with a statistically significant difference in DFS and provide real-world evidence supporting the applicability of Z0011-based axillary management in the Chinese population; however, given the observational design and potential for residual confounding, these results should be interpreted with caution.<\/jats:p>","DOI":"10.3390\/curroncol33050247","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:12:31Z","timestamp":1777363951000},"page":"247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Omission of Axillary Lymph Node Dissection in Breast Cancer Patients with 1\u20132 Positive Sentinel Lymph Nodes: A Multicenter Real-World Cohort Study in a Chinese Population"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0553-801X","authenticated-orcid":false,"given":"Chengye","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongwu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Longyan Second Hospital, Longyan 364000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianqiang","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3524-063X","authenticated-orcid":false,"given":"Debo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4974-774X","authenticated-orcid":false,"given":"Weibin","family":"Lian","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1470-2045(13)70035-4","article-title":"Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): A phase 3 randomised controlled trial","volume":"14","author":"Galimberti","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1385","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":"ref_3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/SLA.0b013e3181f08f32","article-title":"Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: The American College of Surgeons Oncology Group Z0011 randomized trial","volume":"252","author":"Giuliano","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1200\/JCO.2016.71.0947","article-title":"Sentinel Lymph Node Biopsy for Patients with Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update","volume":"35","author":"Lyman","year":"2017","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/XCS.0000000000000950","article-title":"Adherence Rate to Alliance for Clinical Trials in Oncology Z0011 Trial Based on Breast Cancer Subtype","volume":"238","author":"Maramara","year":"2024","journal-title":"J. Am. Coll. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12957-021-02242-1","article-title":"Application of the ACOSOG Z0011 criteria to Chinese patients with breast cancer: A prospective study","volume":"19","author":"Peng","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/S1470-2045(14)70460-7","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial","volume":"15","author":"Donker","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1056\/NEJMoa2313487","article-title":"Omitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases","volume":"390","author":"Filtenborg","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.breast.2022.02.013","article-title":"Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial","volume":"63","author":"Appelgren","year":"2022","journal-title":"Breast"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.surg.2024.08.045","article-title":"Surgical treatments for older breast cancer patients: A systematic review and meta-analysis of real-world evidence","volume":"176","author":"Lai","year":"2024","journal-title":"Surgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1200\/JCO-25-00099","article-title":"Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update","volume":"43","author":"Park","year":"2025","journal-title":"J. Clin. Oncol."},{"key":"ref_12","first-page":"1262","article-title":"Omitting ALND Is Not Safe for a Cohort of Early-Stage Breast Cancer Patients with 1-2 SLNs Macro-Metastases and Breast-Conserving Therapy: A Single-Center Retrospective Study","volume":"49","author":"Wang","year":"2020","journal-title":"Iran. J. Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Yu, Y., Wang, Z., Wei, Z., Yu, B., Shen, P., Yan, Y., and You, W. (2021). Development and validation of nomograms for predicting axillary non-SLN metastases in breast cancer patients with 1\u20132 positive sentinel lymph node macro-metastases: A retrospective analysis of two independent cohorts. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08178-9"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/5\/247\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:31:17Z","timestamp":1777368677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/5\/247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":13,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["curroncol33050247"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33050247","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]}}}