{"doi":"10.1001/jamanetworkopen.2024.59692","title":"Trends in Axillary Lymph Node Dissection After Mastectomy Among Patients With Limited Nodal Burden","abstract":"Importance: Current practices in axillary treatment for patients with breast cancer who receive a mastectomy for node-positive disease are unknown. For patients who receive postmastectomy radiotherapy (PMRT), the addition of axillary lymph node dissection (ALND) may result in significant overtreatment. Objectives: To evaluate trends in axillary treatment for patients with limited nodal metastases who receive a mastectomy and identify factors that can be targeted to reduce axillary overtreatment. Design, Setting, and Participants: A retrospective cohort study was conducted of patients identified from the National Cancer Database who received a diagnosis of breast cancer from January 1, 2012, to December 31, 2021. Patients included were women aged 18 years or older with clinical (c) T1-T2N0 breast cancer who underwent mastectomy with axillary staging with sentinel lymph node biopsy (SLNB) and/or ALND and had 1 to 2 positive lymph nodes. Patients who received neoadjuvant therapies were excluded. Statistical analysis was performed from December 2023 to July 2024. Exposure: Axillary management based on ALND and PMRT receipt: (1) ALND alone, (2) PMRT alone, (3) both ALND and PMRT, and (4) neither ALND nor PMRT. Main Outcomes and Measures: Axillary management strategies were evaluated, and clinicopathologic characteristics based on treatment type were compared with multivariable analysis. Results: In total, 62 332 patients were included (median age, 58 years [IQR, 48-68 years]; 82.2% with Charlson-Deyo comorbidity score 0). The proportion of patients who received ALND alone decreased from 47.1% to 17.6% from 2012 to 2021, while the percentage of patients who received PMRT alone increased from 9.8% to 36.8%. Overall, 21.3% of patients received treatment with both ALND and PMRT, with little change over time (from 21.7% in 2012 to 17.7% in 2021). Most patients (88.4%) who received both PMRT and ALND underwent ALND at the same operation as SLNB. Younger age (odds ratio [OR] per year increase, 0.98 [95% CI, 0.98-0.98]; P < .001), high-grade tumors (grade 2: OR, 1.18 [95% CI, 1.09-1.29]; P < .001; grade 3: OR, 1.34 [95% CI, 1.22-1.48]; P < .001), presence of lymphovascular invasion (OR, 1.26 [1.19-1.33]; P < .001), and larger tumor size (cT2 tumors compared with cT1: OR, 1.10 [95% CI, 1.03-1.17]; P = .004; upstaging to pathologic T3 tumors: OR, 2.29 [95% CI, 1.15-4.99]; P = .03) were associated with increased likelihood of concurrent treatment with ALND and PMRT. Conclusions and Relevance: In this retrospective cohort study of patients with breast cancer who received a mastectomy, a substantial proportion of those with 1 to 2 positive lymph nodes were treated with both ALND and PMRT. Delaying the decision for ALND until after multidisciplinary input may reduce overtreatment.","journal":"JAMA Network Open","year":2025,"id":513685,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9626,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1374904,"name":"Tyler Jones","orcid":"0000-0003-2585-0434","position":1,"is_corresponding":false},{"id":347341,"name":"Samantha M. Thomas","orcid":"0000-0002-1561-9303","position":2,"is_corresponding":false},{"id":870523,"name":"Astrid Botty van den Bruele","orcid":null,"position":3,"is_corresponding":false},{"id":347344,"name":"Laura H. Rosenberger","orcid":"0000-0002-6829-6747","position":4,"is_corresponding":false},{"id":638629,"name":"Akiko Chiba","orcid":"0000-0003-0303-2799","position":5,"is_corresponding":false},{"id":1375470,"name":"Kendra J. Modell Parrish","orcid":null,"position":6,"is_corresponding":false},{"id":1374905,"name":"Lesly A. Dossett","orcid":"0000-0003-3813-8083","position":7,"is_corresponding":false},{"id":347340,"name":"Jennifer K. Plichta","orcid":"0000-0002-7411-0558","position":8,"is_corresponding":false},{"id":423614,"name":"Susan G. R. McDuff","orcid":"0000-0003-2309-6829","position":9,"is_corresponding":false},{"id":944974,"name":"Maggie L. DiNome","orcid":"0000-0002-1926-292X","position":10,"is_corresponding":false},{"id":347345,"name":"E. Shelley Hwang","orcid":"0000-0003-0204-2012","position":11,"is_corresponding":false},{"id":282428,"name":"Ton Wang","orcid":"0000-0003-0437-3771","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:48:17.908238Z","pmid":"39946126","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}