Quality of life of patients with early breast cancer with and without sentinel lymph node biopsy

Background: According to GLOBOCAN (2022), 2.3 million new cases of breast cancer (11.6% of all malignant neoplasms) were diagnosed worldwide, with a mortality rate of 665,684 cases, which is equivalent to 6.9% of all cancer deaths. Breast cancer (BC) ranks first in the structure of cancer morbidity in women and the fourth among causes of death from malignant neoplasms in the general population. In the Russian Federation, the majority (72.5%) of breast cancer cases are diagnosed at early stages (I-II), which creates prerequisites for improving surgical tactics. Despite the fact that surgical treatment remains the main method of therapy, in recent years the possibilities of reducing the volume of intervention in the axillary zone have been actively discussed. Quality of life (QOL) is recognized as the second most important criterion for treatment effectiveness after overall survival (OS). Its assessment is included in the design of many randomized clinical trials and is carried out using standardized questionnaires and validated scales.

Objective: Assessment of the effect of the volume of surgical intervention in the axillary zone on the quality of life in patients with early breast cancer (cT1-2N0).

Materials and methods: The study, conducted at the Herzen Moscow Oncology Research Institute in 2017–2022, included 204 patients with luminal subtypes of primary resectable breast cancer (cT1-2N0). In 51 women, treatment was limited to radiotherapy without surgical intervention on regional lymphatic collectors, while 153 patients underwent sentinel lymph node biopsy (SLNB) with pN0 confirmation. Patients were allocated by pseudorandomization in a 3:1 ratio taking into account clinical and morphological characteristics. All patients received adjuvant treatment. The median age was 58.1 years [49.6–65.3]. Stage IA was diagnosed in 164 (80.4%) women and IIA in 40 (19.6%). Invasive ductal carcinoma was found in 173 (84.8%) cases, luminal A subtype – in 149 (73.0%), moderate tumor differentiation – in 183 (89.7%). Multicentric growth was detected in 16 (7.8%) patients.

Results: The median follow-up was 76.4 months (12.1–96.3). During this period, disease progression was recorded in 9 patients (4.4%): three of those who did not undergo intervention in the axillary zone (5.9%) and six of the patients who underwent SLNB (3.9%). Local recurrence was noted in one case (0.7%) after sentinel node biopsy. Regional recurrences developed in three patients (1.5%): two (3.9%) in the group without surgery and one (0.7%) after SLNB (p = 0.155). Distant metastases were detected in five patients (2.5%). Five-year overall survival was 100% regardless of the extent of intervention. Five-year progression-free survival was 95.2 ± 3.4% in patients without surgery and 98.0 ± 1.1% in patients after SLNB; the median value was not reached. According to the EORTC QLQ-BR23 questionnaire, complications in the arm and shoulder during the first year of follow-up were noted in 4% of patients who did not undergo surgery and in 17% of patients after SLNB (p = 0.012). Moreover, in the first group, all complaints were minimal and corresponded to the degree of «mildly expressed», while after SLNB, in 2–3.3% of patients they were assessed as «significant» (moderate or expressed).

Conclusions: Patients with early breast cancer (cT1-2N0) can be considered candidates for refusal to perform sentinel lymph node biopsy, which reduces the incidence of complications and allows maintaining a satisfactory quality of life without worsening oncological results.