Backgrounds: This study compares the long-term outcomes of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) in clinically node-positive (cN+) breast cancer (BC) patients treated with neoadjuvant therapy (NAT).Methods: We conducted a retrospective analysis of 322 cN+ BC patients who became clinically node-negative (ycN0) post-NAT. Patients were categorized based on the final type of axillary surgery performed: ALND or SLNB. Recurrence-free survival (RFS), distant disease-free survival (DDFS), overall survival (OS), and breast cancer-specific survival (BCSS) were evaluated and compared between the two groups. Results: Patients in the SLNB group had significantly better 3-, 5-, and 10-year RFS, DDFS, OS, and BCSS compared to those in the ALND group. The SLNB group also had a higher proportion of patients achieving pathologic complete response (pCR). Multivariate analysis identified pCR, ypN0 status, and SLNB as favorable prognostic factors for all survival metrics. Axillary recurrence rates were low for both groups (0.6–2.1%). Conclusions: SLNB may be a safe and effective alternative to ALND for selected cN+ BC patients who convert to ycN0 after NAT. These findings suggest that careful patient selection is crucial, and further research is needed to validate these results in more comparable populations.
背景：本研究比较了临床淋巴结阳性（cN+）乳腺癌（BC）患者接受新辅助治疗（NAT）后，腋窝淋巴结清扫术（ALND）与哨淋巴结活检（SLNB）的长期预后差异。 方法：我们对322例NAT后转为临床淋巴结阴性（ycN0）的cN+ BC患者进行回顾性分析。根据最终实施的腋窝手术类型（ALND或SLNB）将患者分组，评估并比较两组间的无复发生存期（RFS）、无远处转移生存期（DDFS）、总生存期（OS）及乳腺癌特异性生存期（BCSS）。 结果：与ALND组相比，SLNB组患者的3年、5年及10年RFS、DDFS、OS和BCSS均显著更优。SLNB组获得病理完全缓解（pCR）的患者比例也更高。多变量分析显示，pCR、ypN0状态及SLNB是所有生存指标的有利预后因素。两组腋窝复发率均较低（0.6%–2.1%）。 结论：对于NAT后转为ycN0的特定cN+ BC患者，SLNB可能是替代ALND的安全有效选择。这些发现提示，细致的患者筛选至关重要，未来需在更具可比性的人群中进一步验证上述结果。
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