Faculty Collaboration Database

Contemporary Nodal Management and Overall Survival of Older Patients with HR-/HER2+ Breast Cancer. Ann Surg Oncol 2026 Jan;33(1):118-128

Date

09/30/2025

Pubmed ID

41023545

Pubmed Central ID

PMC12558606

DOI

10.1245/s10434-025-18417-z

Scopus ID

2-s2.0-105018229193 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

BACKGROUND: Contemporary guidelines recommend omission of surgical nodal staging for patients age 70 years or older with early-stage cN0 HR+/HER2- breast cancer (BC) but exclude those with HER2+BC. This study aimed to investigate surgical nodal management of patients age 70 years or older with HR-/HER2+BC, analyze overall survival (OS) by nodal surgery type, and identify factors associated with surgical nodal omission.

METHODS: The study enrolled women age 70 years or older with stages I to III HR-/HER2+BC in the National Cancer Database (NCDB) who underwent upfront surgery from 2017 to 2019. Nodal management was defined by the number of nodes examined as follows: omission (0 nodes), SLNB (1-5 nodes), and ALND (>10 nodes). Multinomial logistic regression and Kaplan-Meier analysis were performed.

RESULTS: Of 1853 patients, 42.8 % were age 70 to 75 years, and 74.5 % had a Charlson Comorbidity Index (CCI) of 0. Most (90 %) had stage I or II disease and had undergone lumpectomy (57.2 %). Overall, 10.5 % had omission of nodal surgery, whereas 68.1 % had SLNB and 9.8 % had ALND. The 3-year OS was worse for the patients with omission (58 %) than for those with SLNB (88 %) or ALND (69 %) (p < 0.01). The factors associated with omission were age older than 81 years (odds ratio [OR], 4.4; 95 % confidence interval [CI], 2.7-6.9) and stage III disease (OR, 2.2; 95 % CI 1.1-4.9). The patients with nodal omission were twice as likely to die as those with SLNB (hazard ratio, 2.0; 95 % CI 1.5-2.7).

CONCLUSION: In this cohort, 10.5 % of the patients with HR-/HER2+BC had omission of nodal surgery, including some patients with locally advanced and cN+ disease. Nodal omission was associated with inferior OS. Nodal staging should remain the standard of care for this population, except for those whose management or survival would not be altered by it.

Author List

Cobb AN, Dong X, Makope A, Cohen L, Huang CC, Kong AL, Cortina CS

Authors

Adrienne Cobb MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Chandler S. Cortina MD Associate Professor in the Surgery department at Medical College of Wisconsin
Amanda L. Kong MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Breast Neoplasms
Female
Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Neoplasm Staging
Prognosis
Receptor, ErbB-2
Receptors, Estrogen
Receptors, Progesterone
Sentinel Lymph Node Biopsy
Survival Rate