Impact of Radical Surgery on Outcome in Locally Advanced Breast Cancer Patients Without Metastasis at the Time of Diagnosis

Background/Aim: In the era of F-18-fluorodeoxy-glucose positron emission tomography/computed tomography ((18)FDG-PET/CT), more patients are being diagnosed with N3M0 disease. The objective of this study was to assess the prognostic impact of radical lymph node surgery (RLNS) in patients with locally advanced breast cancer classified as lymph node N3 disease according to the American Joint Committee on Cancer (AJCC) 2002 in whom there is no known distant metastasis and in the context of multimodal therapy. Patients and Methods: This was a two-Center retrospective study that included patients with breast cancer classified as N3M0 after (18)FDG-PET/CT assessment. We reviewed the clinical characteristics, surgical treatment and oncological outcomes of those patients. Results: Thirty-nine patients fulfilled the inclusion criteria. Multimodal treatment included neo-adjuvant chemotherapy (n=34), adjuvant radiotherapy (n=33), adjuvant chemotherapy (n=18) or neo- or adjuvant hormone therapy (n=17). Surgical treatment was not homogeneous. Eight patients had undergone RLNS and 31 conventional axillary lymph node dissection (CD). There was no significant difference in median overall survival between the RLNS group and the CD group (32 months (28-36) vs. 49 months (42-56) respectively (p=0.25)). The overall recurrence rate was 23%. Out of the 8 patients who had undergone RLNS, three had relapsed (two with distant metastases and one local). Conclusion: RLNS was not proven to be beneficial in our study. In order to guide surgical nzanagement for these patients, PET/CT and magnetic resonance imaging (MRI) could be of interest, therefore a pilot study to improve reproducible surgical management would be of interest.