Long‑term outcomes and quality of life in cT1–2cN0 early breast cancer: impact of axillary surgery extent

Introduction. In Russia, 72.5% of newly diagnosed breast cancer (BC) cases are detected at early stages. Nodal status remains a key factor in determining the extent of surgical treatment. Although sentinel lymph node biopsy (SLNB) is the standard staging procedure for cN0 disease, large prospective trials have demonstrated that SLNB can be safely omitted in selected patients with cT1–2N0 tumors. Aim . This study aims to evaluate long-term oncologic outcomes and quality-of-life parameters in patients with cT1–2cN0 breast cancer according to the extent of axillary surgery. Materials and methods . This study included 204 patients with luminal subtypes of primary operable breast cancer treated at the P. Hertsen Moscow Oncology Research Institute (MORI) between 2017 and 2022. Patients were assigned to two groups: SLNB omitted (Group I, n = 51) and SLNB performed (Group II, n = 153). Allocation was carried out using pseudorandomization in a 1:3 ratio stratified by clinical and morphologic tumor characteristics. The mean patient age was 58.1 years. Quality of life was assessed using the EORTC QLQ-BR23 questionnaire during the first postoperative year. Results. The median follow-up was 76.8 months. Disease progression occurred in 4.4% of patients. Regional recurrences were observed in 1.5% of cases, and distant metastases in 2.5%. Median progression-free survival and overall survival were not reached. Five-year overall survival was 100%. Recurrence-free survival was 95.2 ± 3.4% in Group I and 98.0 ± 1.1% in Group II (p > 0.05). Shoulder and arm symptoms during the first year were reported by 4% and 17% of patients, respectively (p = 0.012). Discussion. Our findings are consistent with international evidence: in patients with cT1–2cN0 luminal breast cancer, SLNB can be safely omitted without compromising oncologic outcomes. Avoiding axillary lymph node dissection is associated with lower rates of lymphedema, pain, and reduced arm mobility, thereby improving quality of life. Multicenter studies support the trend toward de-escalation of axillary surgery while maintaining survival outcomes. Conclusion . Patients with cT1–2cN0 luminal breast cancer may be considered candidates for omission of SLNB without loss of oncologic efficacy.

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