Evidence map›Paper›PMID 37531016›Full record

ArticleBreast cancer research and treatment2023

Impact of axillary surgery on outcome of clinically node positive breast cancer treated with neoadjuvant chemotherapy.

Joseph Dux, Mehran Habibi, Hadi Malik, Lisa Jacobs, Pamela A Wright, Julie Lange, Melissa Camp, Maureen O'Donnell, Bonnie Sun, Hanh-Tam Tran and 1 more

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Article in Breast cancer research and treatment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Joseph DuxDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA. mdduxj@gmail.com.ORCID http://orcid.org/0009-0001-3912-2457
Mehran HabibiDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Hadi MalikDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Lisa JacobsDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Pamela A WrightDepartment of Surgery, Suburban Hospital, Johns Hopkins Medicine, Bethesda, MD, USA.
Julie LangeDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Melissa CampDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Maureen O'DonnellDepartment of Surgery, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC, USA.
Bonnie SunDepartment of Surgery, Suburban Hospital, Johns Hopkins Medicine, Bethesda, MD, USA.
Hanh-Tam TranDepartment of Surgery, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC, USA.
David EuhusDepartment of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAxillary Lymph Node Dissection (ALND) is recommended for breast cancer patients who present with clinically node positive disease (cN1) especially if they have residual nodal disease (ypN+) following neoadjuvant therapy (NAT). It is unknown whether axillary dissection improves outcome for these patients.

methodsA prospectively maintained database was used to identify all patients who were diagnosed with cTis-T4N1M0 breast cancer treated with NAT.

resultsIn our study, of 292 cN1 breast cancer patients who received NAT, we compared ALND with targeted axillary surgery (TAS) in ypN+ patients. ALND was performed in 75% of the ypN+ subgroup, while 25% underwent TAS. Axillary recurrence occurred in four ALND patients, but no recurrence was observed in the TAS group (p = 0.21). Five-year axillary recurrence-free survival was 100% for TAS and 90% for ALND (p = 0.21). Overall survival at five years was 97% for TAS and 85% for ALND (p = 0.39). Disease-free survival rates at five years were 51% for TAS and 61% for ALND (p = 0.9). Clinicopathological variables were similar between the groups, although some differences were noted. ALND patients had smaller clinical tumor size, larger pathological tumor size, more lymph nodes retrieved, larger tumor deposits, higher rates of extranodal extension, and greater prevalence of macrometastatic nodal disease. Tumor subtype and size of lymph node tumor deposit independently predicted survival.

conclusionAxillary recurrence is infrequent in cN1 patients treated with NAT. Our study found that ALND did not reduce the occurrence of axillary recurrence or enhance overall survival. It is currently uncertain which patients benefit from axillary dissection.

Indexed as

Breast NeoplasmsAxillaFemaleHumansLymphatic MetastasisLymph Node ExcisionLymph NodesNeoadjuvant TherapySentinel Lymph Node BiopsyAxillary dissectionBreast cancerNeoadjuvant chemotherapyNode positiveTargeted axillary surgery

Identifiers

PMID37531016

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.