Surgical axillary staging in elderly patients with initially node-positive breast cancer after neoadjuvant chemotherapy – data from the prospective AXSANA study (NCT04373655/EUBREAST-03/AGO-B-053 study)
Senologie - Zeitschrift für Mammadiagnostik und -therapie, vol. 22
Abstract
Background: Breast cancer treatment for older, physically fit patients should be equal to that for younger patients. It is unclear whether this is the case for surgical axillary staging after neoadjuvant systemic therapy (NAST). This analysis compares surgical axillary staging after NAST for patients<70 and≥70 years of age. Material and methods: AXSANA is an ongoing international prospective cohort study including initially cN+-patients converting to ycN0-status after NAST. The axillary staging technique is in accordance to the standard at the respective institution. Primary endpoints are invasive disease-free survival, axillary recurrence rate and health-related quality of life. All patients, whose surgical therapy after NAST had been completed by January 6, 2025, were included in the current analysis. Results: 3.089 (67.9%) of 4,549 eligible patients had converted to ycN0, 210 of whom (6.8%) were≥70 years. The proportion of patients receiving marking of the target lymph node before NAST was not different between patients<70 versus≥70 years (60.3 vs. 63.8%, p=0.296). The planned axillary staging did not differ between age groups either: axillary lymph node dissection (ALND) was performed in 29.8% versus 32.9% and less extensive surgery (sentinel lymph node biopsy, target lymph node biopsy or targeted axillary dissection) in 70.2% versus 67.1% (p=0.394). ALND was the final axillary intervention in 51.9% of patients (51.8% versus 52.9%, p=0.769). Conclusion: There was no significant difference in the surgical axillary staging strategy after NAST in this large study cohort between patients<70 years and those≥70 years. Publication History Article published online: 04 June 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Authors 43
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Affiliation as printed
University Hospital Rostock, Department of Gynecology and Obstetrics, Rostock, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
University Hospital Schleswig-Holstein, Campus Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany
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Karolinska Institutet · Saint Göran Hospital
Affiliation as printed
Capio St. Göran's Hospital, Department of Surgery, Stockholm, Sweden
Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
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Affiliation as printed
University Hospital Augsburg, Department of Gynecology and Obstetrics, Augsburg, Germany
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Vita-Salute San Raffaele University · IRCCS Ospedale San Raffaele
Affiliation as printed
IRCCS San Raffaele Scientific Institute, Breast Unit, Milan, Italy
Università Vita-Salute San Raffaele, Milan, Italy
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Zonguldak Bülent Ecevit University
Affiliation as printed
Zonguldak BEUN The School of Medicine, Breast and Endocrine Unit, General Surgery Department, Kozlu/Zonguldak, Turkey
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Affiliation as printed
University Hospital Aachen, Department of Gynecology and Obstetrics, Aachen, Germany
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Affiliation as printed
AGAPLESION Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
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Brüderkrankenhaus St. Josef Paderborn
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Kliniken Salzkotten+Paderborn, Kooperatives Brustzentrum Paderborn, Paderborn, Germany
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Medizinische Hochschule Brandenburg Theodor Fontane
Affiliation as printed
Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
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Affiliation as printed
Klinikum Stuttgart, Department of Gynecology and Obstetrics, Stuttgart, Germany
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Affiliation as printed
Medical University of Graz, Department of Gynecology and Obstetrics, Graz, Austria
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University Hospital Schleswig-Holstein
Affiliation as printed
University Hospital Schleswig-Holstein, Campus Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany
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Iuliu Hațieganu University of Medicine and Pharmacy · Institute of Oncology Prof. Dr. Ion Chiricuta
Affiliation as printed
"Iuliu Hațieganu" University of Medicine and Pharmacy, 11th Department of Oncological Surgery and Gynecological Oncology, Cluj-Napoca, Romania
"Prof. Dr. Ion Chiricuță" Institute of Oncology, Department of Surgical Oncology, Cluj-Napoca, Romania
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Vita-Salute San Raffaele University
Affiliation as printed
Università Vita-Salute San Raffaele, Milan, Italy
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Charles University · General University Hospital in Prague
Affiliation as printed
First Faculty of Medicine, Charles University, General University Hospital, Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Prague, Czech Republic
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Ospedale regionale di Lugano · Università della Svizzera italiana
Affiliation as printed
Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Department of Gynecology and Obstetrics, Lugano, Switzerland
University of the Italian Switzerland (USI), Faculty of Biomedicine, Lugano, Switzerland
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Affiliation as printed
Faculty of Medicine, Medical University, Department of Surgical Oncology, Pleven, Bulgaria
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Affiliation as printed
University Hospital Center "Nene Tereza", Oncology Hospital, Tirana, Albania
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Affiliation as printed
Max Institute of Cancer Care, Max Healthcare Delhi, Breast Surgical Oncology and Oncoplastic Surgery, Delhi, India
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National and Kapodistrian University of Athens
Affiliation as printed
Laiko Hospital, National and Kapodistrian University of Athens, 1st Department of Surgery, Athens, Greece
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St Thomas' Hospital · King's College London · Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Guy's and St Thomas' NHS Foundation Trust, Department of Breast Surgery, London, United Kingdom
Kings College, Life Sciences and Medicine, London, United Kingdom
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Affiliation as printed
University of Zielona Góra, Collegium Medicum, Zielona Góra, Poland
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University of Helsinki · Helsinki University Hospital
Affiliation as printed
Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Breast Surgery Unit, Helsinki, Finland
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Affiliation as printed
Medical University of Graz, Graz, Austria
Medical University of Graz, Institute of Pathology, Graz, Austria
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Institute of Oncology Ljubljana
Affiliation as printed
Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Affiliation as printed
Champalimaud Clinical Center, Champalimaud Foundation, Breast Unit, Lisboa, Portugal
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Affiliation as printed
Azerbaijan Medical University, Oncology Department, Baku, Azerbaijan
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Instituto Nacional de Enfermedades Neoplásicas
Affiliation as printed
Instituto Nacional de Enfermedades Neoplasicas, Department of Research, Lima, Peru
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Clinica Universidad de Navarra
Affiliation as printed
Clínica Universidad de Navarra, Breast Surgical Unit, Madrid, Spain
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Affiliation as printed
Oslo University Hospital, Department for Breast and Endocrine Surgery, Oslo, Norway
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St Thomas' Hospital · Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Guy's and St Thomas' NHS Foundation Trust, Department of Breast Surgery, London, United Kingdom
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Chulalongkorn University · King Chulalongkorn Memorial Hospital
Affiliation as printed
King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Queen Sirikit Centre for Breast Cancer, Bangkok, Thailand
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Universitair Ziekenhuis Brussel
Affiliation as printed
University Hospital Brussels, Breast Clinic, Brussels, Belgium
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Tel Aviv University · Sheba Medical Center
Affiliation as printed
Chaim Sheba Medical Center, Department of Surgery C, Ramat Gan, Israel
Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
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Affiliation as printed
University Hospital Tübingen, Department of Women’s Health, Tübingen, Germany
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Evangelisches Diakoniekrankenhaus
Affiliation as printed
Evangelisches Diakoniekrankenhaus, Freiburg, Germany
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Affiliation as printed
Klinikum Aschaffenburg-Alzenau, Department of Gynecology and Obstetrics, Aschaffenburg, Germany
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TUM Klinikum · Technical University of Munich
Affiliation as printed
Klinikum rechts der Isar, Technische Universität München, Department of Obstetrics and Gynecology, München, Germany
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Affiliation as printed
Marienhospital Bottrop, Department of Gynecology and Obstetrics, Bottrop, Germany
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Affiliation as printed
AGO-B Breast Study Group e.V., Berlin, Germany
Helios Klinikum Berlin-Buch, Berlin, Germany
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Affiliation as printed
German Breast Group, Neu-Isenburg, Germany
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Affiliation as printed
Filderklinik, Department of Gynecology and Obstetrics, Filderstadt-Bonlanden, Germany
University Hospital Ulm, Department of Gynecology and Obstetrics, Ulm, Germany
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