Paluskievicz Christina M, Vasigh Mahtab, Rath Piyush, Lee Seoho, Jacobs Lisa, Camp Melissa, Lange Julie, Euhus David, Wright Pam, Sun Bonnie, Tran Hanh-Tam, O'Donnell Maureen, Sogunro Olutayo
Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, USA.
Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, USA.
Cureus. 2025 Jul 25;17(7):e88753. doi: 10.7759/cureus.88753. eCollection 2025 Jul.
Background The most optimal surgical strategy for ipsilateral isolated axillary recurrence (AR) in breast cancer is unknown. Axillary lymph node dissection (ALND) has historically been implemented; however, there may be an evolving role for targeted axillary dissection (TAD). Methods A retrospective analysis was conducted on patients with invasive breast cancer, followed by AR. Clinical and operative strategies were collected, with primary endpoints including overall survival (OS) and progression-free survival (PFS). Results In total, 21 (10.2%) patients were identified with AR. Of this subset of patients, 15 (71.4%) underwent ALND, and six (28.6%) underwent TAD. Univariable and multivariable analyses did not observe a significant association between TAD versus ALND at the time of recurrence with PFS. Univariable analysis demonstrated a significant association between adjuvant radiation and endocrine therapy at first recurrence and PFS benefit. Conclusions Following AR, no PFS benefit was observed between those managed with TAD versus ALND, which highlights an additional area of consideration for possible axillary de-escalation.
背景 乳腺癌同侧孤立性腋窝复发（AR）的最佳手术策略尚不清楚。历史上一直采用腋窝淋巴结清扫术（ALND）；然而，靶向腋窝清扫术（TAD）的作用可能在不断演变。方法 对浸润性乳腺癌伴AR的患者进行回顾性分析。收集临床和手术策略，主要终点包括总生存期（OS）和无进展生存期（PFS）。结果 共确定21例（10.2%）患者发生AR。在这部分患者中，15例（71.4%）接受了ALND，6例（28.6%）接受了TAD。单因素和多因素分析未观察到复发时TAD与ALND在PFS方面存在显著关联。单因素分析显示首次复发时辅助放疗和内分泌治疗与PFS获益之间存在显著关联。结论 AR发生后，TAD与ALND治疗患者之间未观察到PFS获益，这突出了腋窝降阶梯治疗可能需要额外考虑的一个方面。
