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Multicenter Study
. 2025 Feb;32(2):952-966.
doi: 10.1245/s10434-024-16472-6. Epub 2024 Dec 2.

Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03

Neslihan Cabioglu  1 , Hasan Karanlik  2 , Abdullah Igci  3   4 , Mahmut Muslumanoglu  3 , Mehmet Ali Gulcelik  5 , Cihan Uras  6 , Havva Belma Kocer  7 , Didem Can Trabulus  8   9 , Enver Ozkurt  10 , Guldeniz Karadeniz Cakmak  11 , Mustafa Tukenmez  3 , Suleyman Bademler  2 , Nilufer Yildirim  4 , Gökhan Giray Akgul  5 , Ebru Sen  12 , Kazim Senol  13 , Selman Emiroglu  3 , Bulent Citgez  14   15 , Yeliz Emine Ersoy  16 , Ahmet Dag  17 , Baha Zengel  18   19 , Gul Basaran  20 , Halil Kara  6 , Ece Dilege  21 , M Umit Ugurlu  22 , Atilla Celik  23 , Serkan Ilgun  10   24 , Yasemin Bolukbasi  25 , Niyazi Karaman  26 , Gürhan Sakman  27 , Serdar Ozbas  28 , Halime Gul Kilic  3 , Ayfer Kamali Polat  29 , Ibrahim Ali Ozemir  30 , Berkay Kilic  2 , Ayse Altınok  31 , Ecenur Varol  32 , Lutfi Dogan  26 , Alper Akcan  33 , Beyza Ozcinar  3 , Leyla Zer  34 , Aykut Soyder  35 , Mehmet Velidedeoglu  36 , Fazilet Erozgen  37 , Berk Goktepe  38 , Mutlu Dogan  39 , Abut Kebudi  40 , Banu Yigit  14   23 , Burak Celik  21 , Serdar Yormaz  41 , Cumhur Arici  42 , Orhan Agcaoglu  21 , Ali Ibrahim Sevinc  43 , M Kemal Atahan  44 , Vafa Valiyeva  45 , Elif Baran  14 , Israa Aljorani  13 , Zafer Utkan  32 , Levent Yeniay  38 , Taner Kivilcim  40 , Atilla Soran  46 , Adnan Aydiner  47 , Kamuran Ibis  48 , Vahit Ozmen  3   49
Affiliations
Multicenter Study

Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03

Neslihan Cabioglu et al. Ann Surg Oncol. 2025 Feb.

Abstract

Background: This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC).

Methods: The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC.

Results: A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0.

Conclusions: The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

Keywords: Axillary dissection; Axillary recurrence; Breast cancer recurrence; Locoregional recurrence; Neoadjuvant chemotherapy; Non-luminal pathology; Regional nodal irradiation; Sentinel lymph node biopsy; Survival; Young age.

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Conflict of interest statement

Disclosures: The authors declare that they have no conflict of interest.

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