A multidisciplinary approach to axillary management in early-stage breast cancer: a systematic and meta-analysis

Background: Axillary management in early-stage breast cancer has evolved from routine axillary lymph node dissection (ALND) toward less invasive strategies, including sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). However, optimal integration of surgical, radiological, and oncological approaches remains debated. Objective: This systematic review and meta-analysis evaluated the efficacy, safety, and oncological outcomes of multidisciplinary axillary management strategies in early-stage breast cancer (cT۱-۲N۰). Methods: PubMed, Scopus, and Web of Science were searched from ۲۰۱۵–۲۰۲۵ for randomized controlled trials and prospective cohort studies comparing multidisciplinary approaches (SLNB ± TAD ± nodal radiotherapy) versus ALND. Primary outcomes: axillary recurrence rate (ARR), overall survival (OS), disease-free survival (DFS), and morbidity (lymphedema). Pooled risk ratios (RRs) and hazard ratios (HRs) with ۹۵% confidence intervals (CIs) were calculated using random-effects models. Results: Fourteen studies (n=۸,۷۴۲ patients) met inclusion criteria. Multidisciplinary management significantly reduced lymphedema (RR ۰.۳۲; ۹۵% CI ۰.۲۱–۰.۴۸; p<۰.۰۰۱) without compromising ARR (RR ۱.۱۲; ۹۵% CI ۰.۶۷–۱.۸۷; p=۰.۶۷). OS (HR ۰.۹۶; ۹۵% CI ۰.۸۹–۱.۰۴) and DFS (HR ۰.۹۸; ۹۵% CI ۰.۹۱–۱.۰۶) were equivalent between groups. Subgroup analysis showed TAD and nodal radiotherapy achieved lowest axillary failure rates (۱.۲%). Conclusion: A multidisciplinary approach incorporating SLNB, TAD, and selective nodal irradiation provides equivalent oncological safety with significantly reduced morbidity compared to ALND. These findings support de-escalation of axillary surgery in early-stage breast cancer.

کلیدواژه ها:

Axillary management ، early-stage breast cancer ، sentinel lymph node biopsy ، targeted axillary dissection ، Multidisciplinary approach