对于在新辅助全身治疗（NAST）中实现完全临床缓解（cCR）的临床N1（cN1）激素受体阳性（HR +），人类表皮生长因子受体2（HER2）/neu阴性（HER2 -）浸润性导管癌（IDC）患者，腋窝管理因_SENTINEL淋巴结活检（SLNB）和腋窝淋巴结清扫（ALND）而异。本研究旨在评估此患者亚组中SLNB与ALND的临床实践模式和生存结果。从2012年至2017年的全国癌症数据库（NCDB）中确定具有cN1、HR+/HER2-、单侧IDC且对NAST表现出cCR的患者，并根据最终腋窝手术处理方式（SLNB vs ALND）进行分层。经倾向评分匹配后，使用Kaplan-Meier分析比较总生存率（OS），并使用Cox回归分析确定显著的OS预测因子。在本研究中，共选择了1676名患者，其中593名（35.4%）接受SLNB，1083名（64.6%）接受ALND。在2012年至2017年间，SLNB的使用增加了28%。在584名匹配患者中，平均OS在SLNB和ALND之间没有差异（所有患者[92.1 ± 0.8 vs 90.2 ± 1.0个月；p = 0.157]，ypN0患者[92.4 ± 0.8 vs 89.9 ± 0.9个月；p = 0.105]，ypN +患者[83.5 ± 2.3 vs 91.7 ± 2.7个月；p ± 0.963)。 Cox回归分析确定年龄、Charlson评分、临床T分期和病理淋巴结状态是OS的显著预测因子。本分析表明，在对NAST实现cCR的cN1、HR+/HER2- IDC患者中，最终的手术管理策略对生存结果没有显著影响。在此患者亚组中存在减少腋窝管理的潜在机会，需要进行验证研究。© 2023年，外科学肿瘤学学会。

Axillary management varies between sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) for patients with clinical N1 (cN1), hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)/neu-negative (HER2-), infiltrative ductal carcinoma (IDC) who achieve a complete clinical response (cCR) to neoadjuvant systemic therapy (NAST). This study sought to evaluate clinical practice patterns and survival outcomes of SLNB versus ALND in this patient subset.Patients with cN1, HR+/HER2-, unilateral IDC demonstrating a cCR to NAST were identified from the 2012-2017 National Cancer Database (NCDB) and stratified based on final axillary surgery management (SLNB vs ALND). After propensity score-matching, overall survival (OS) was compared using a Kaplan-Meier analysis, and significant OS predictors were identified using Cox regression.Of the 1676 patients selected for this study, 593 (35.4%) underwent SLNB and 1083 (64.6%) underwent ALND. Use of SLNB increased by 28 % between 2012 and 2017. Among a total of 584 matched patients, 461 matched ypN0 patients, and 108 matched ypN+ patients, mean OS did not differ between SLNB and ALND (all patients [92.1 ± 0.8 vs 90.2 ± 1.0 months; p = 0.157], ypN0 patients [92.4 ± 0.8 vs 89.9 ± 0.9 months; p = 0.105], ypN+ patients [83.5 ± 2.3 vs 91.7 ± 2.7 months; p ± 0.963). Cox regression identified age, Charlson score, clinical T stage, and pathologic nodal status as significant predictors of OS.The final surgical management strategy used for cN1, HR+/HER2- IDC patients who achieved a cCR to NAST did not have a significant impact on survival outcomes in this analysis. Potential opportunities for de-escalation of axillary management among this patient subset exist, and validation studies are needed.© 2023. Society of Surgical Oncology.