Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society

Bong Kyun Kim; Joohyun Woo; Jeeyeon Lee; Eunhye Kang; Soo Yeon Baek; Seokwon Lee; Hyouk Jin Lee; Jina Lee; Woo Young Sun; Korean Breast Cancer Society

doi:10.4048/jbc.2023.0221

Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society

J Breast Cancer. 2024 Feb;27(1):1-13. doi: 10.4048/jbc.2023.0221.

Authors

Bong Kyun Kim¹, Joohyun Woo², Jeeyeon Lee³, Eunhye Kang⁴, Soo Yeon Baek⁵, Seokwon Lee⁶, Hyouk Jin Lee⁷, Jina Lee¹, Woo Young Sun⁸; Korean Breast Cancer Society

Affiliations

¹ Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
² Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
³ Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
⁴ Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
⁵ Department of Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
⁶ Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
⁷ Breast-Thyroid Center, Saegyaero Hospital, Busan, Korea.
⁸ Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sun2729@naver.com.

Abstract

Purpose: In total mastectomy (TM), sentinel lymph node biopsy (SLNB) is recommended but can be omitted for breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS). However, concerns regarding SLNB-related complications and their impact on quality of life exist. Consequently, further research is required to evaluate the role of axillary surgeries, including SLNB, in the treatment of TM. We aimed to explore the clinicopathological factors and outcomes associated with axillary surgery in patients with a final diagnosis of pure DCIS who underwent BCS or TM.

Methods: We retrospectively analyzed large-scale data from the Korean Breast Cancer Society registration database, highlighting on patients diagnosed with pure DCIS who underwent surgery and were categorized into two groups: BCS and TM. Patients were further categorized into surgery and non-surgery groups according to their axillary surgery status. The analysis compared clinicopathological factors and outcomes according to axillary surgery status between the BCS and TM groups.

Results: Among 18,196 patients who underwent surgery for DCIS between 1981 and 2022, 11,872 underwent BCS and 6,324 underwent TM. Both groups leaned towards axillary surgery more frequently for large tumors. In the BCS group, clinical lymph node status was associated with axillary surgery (odds ratio, 11.101; p = 0.003). However, in the TM group, no significant differences in these factors were observed. Survival rates did not vary between groups according to axillary surgery performance.

Conclusion: The decision to perform axillary surgery in patients with a final diagnosis of pure DCIS does not affect the prognosis, regardless of the breast surgical method. Furthermore, regardless of the breast surgical method, axillary surgery, including SLNB, should be considered for high-risk patients, such as those with large tumors. This may reduce unnecessary axillary surgery and enhance the patients' quality of life.

Keywords: Carcinoma, Intraductal, Noninfiltrating; Mastectomy; Sentinel Lymph Node; Survival.