ArticleAnnals of surgical oncology2026
Contemporary Nodal Management and Overall Survival of Older Patients with HR-/HER2+ Breast Cancer.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.
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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.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Reply to: Letter to the Editor of Annals of Surgical Oncology Concerning "Evaluating Survival and Treatment Patterns Using the National Cancer Database in HER2-Positive Breast Cancer," by Sanli, Deniz et al.Annals of surgical oncology · 2026Article
- ASO Author Reflections: Prognostic and Therapeutic Implications of Nodal Burden in HER2-Positive Breast Cancer.Annals of surgical oncology · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
Abstract
backgroundContemporary guidelines recommend omission of surgical nodal staging for patients age 70 years or older with early-stage cN0 HR+/HER2- breast cancer (BC) but exclude those with HER2+BC. This study aimed to investigate surgical nodal management of patients age 70 years or older with HR-/HER2+BC, analyze overall survival (OS) by nodal surgery type, and identify factors associated with surgical nodal omission.
methodsThe study enrolled women age 70 years or older with stages I to III HR-/HER2+BC in the National Cancer Database (NCDB) who underwent upfront surgery from 2017 to 2019. Nodal management was defined by the number of nodes examined as follows: omission (0 nodes), SLNB (1-5 nodes), and ALND (>10 nodes). Multinomial logistic regression and Kaplan-Meier analysis were performed.
resultsOf 1853 patients, 42.8 % were age 70 to 75 years, and 74.5 % had a Charlson Comorbidity Index (CCI) of 0. Most (90 %) had stage I or II disease and had undergone lumpectomy (57.2 %). Overall, 10.5 % had omission of nodal surgery, whereas 68.1 % had SLNB and 9.8 % had ALND. The 3-year OS was worse for the patients with omission (58 %) than for those with SLNB (88 %) or ALND (69 %) (p < 0.01). The factors associated with omission were age older than 81 years (odds ratio [OR], 4.4; 95 % confidence interval [CI], 2.7-6.9) and stage III disease (OR, 2.2; 95 % CI 1.1-4.9). The patients with nodal omission were twice as likely to die as those with SLNB (hazard ratio, 2.0; 95 % CI 1.5-2.7).
conclusionIn this cohort, 10.5 % of the patients with HR-/HER2+BC had omission of nodal surgery, including some patients with locally advanced and cN+ disease. Nodal omission was associated with inferior OS. Nodal staging should remain the standard of care for this population, except for those whose management or survival would not be altered by it.
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