A retrospective study on axilla treatment for breast cancer with sentinel lymph node micrometastases

This study examined the risk factors associated with the prognosis and analyzed the prognostic impact of axillary lymph node dissection (ALND) or radiotherapy on patients with sentinel lymph node (SLN) micrometastases to identify specific populations in which ALND can be omitted. A retrospective analysis of patients with pT1-3N1miM0 breast cancer was conducted. Patients were divided into SLN biopsy (SLNB) and SLNB + ALND groups. Cox proportional hazard model and logistic regression analyses were performed to identify independent risk factors associated with survival. Propensity score matching was performed to balance patient characteristics. The Kaplan-Meier method was used to plot survival curves. Of the 320 patients enrolled, 104 cases in each group were successfully matched. There were no differences in locoregional recurrence rate (LRR), disease-free survival, or overall survival between the SLNB and SLNB + ALND groups. Univariate and multivariate analyses identified progesterone receptor-negative status (odds ratio = 25, 95% confidence interval, 1.27-Inf, P = .035) and lymph vascular invasion (odds ratio = 77.21, 95% confidence interval, 6.30-945.65, P < .001) as risk factors for LRR, but these factors were no longer risk factors after propensity score matching. When the SLNB or SLNB + ALND groups were further divided into radiotherapy and no-radiotherapy subgroups, radiotherapy was found to have no effect on prognosis. Neither ALND nor radiotherapy impacts the LRR, disease-free survival, or overall survival of patients with breast cancer with SLN micrometastases. Local treatment, such as ALND or radiotherapy, is recommended for patients with SLN micrometastases with risk factors such as progesterone receptor-negative status or lymph vascular invasion if subsequent systemic treatment cannot be guaranteed.