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)

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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

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