ArticleAnnals of medicine2026
Axillary treatment options in clinically nodes-positive breast cancer whose nodes become pathologically nodes-negative after neoadjuvant chemotherapy: a pairwise and network meta-analysis.
Article in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeoadjuvant chemotherapy (NAC) has increased heterogeneity in regional axillary management. The optimal strategy remains uncertain for patients with clinically node-positive (cN+) breast cancer (BC) who convert to pathologically node-negative (ypN0) status after NAC. This study aimed to identify the most appropriate axillary treatment strategies for this subgroup. MATERIALS AND
methodsPubMed, Web of Science, Embase, and the Cochrane Library were searched for studies published up to July 2025. Pairwise meta-analysis and Bayesian network meta-analysis (NMA) were conducted in R to compare survival outcomes. The primary endpoints were overall survival (OS) and disease-free survival (DFS). Comparative efficacy was summarized using forest plots, league tables, and surface under the cumulative ranking curve (SUCRA) values.
resultsTwenty studies on 19,870 patients were analyzed. In pairwise comparisons, sentinel lymph node biopsy (SLNB) plus regional nodal irradiation (RNI) was associated with worse OS than SLNB alone (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.09-1.51; I
conclusionIn patients with cN + BC who achieve ypN0 status after NAC, tailored axillary strategies yielded survival outcomes comparable to conventional approaches. SLNB ranked highest for OS in the NMA, supporting its role as an effective and less invasive option in appropriately selected patients. However, these findings are largely based on retrospective data. Prospective studies with long-term follow-up are needed for confirmation.
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