Abstract
BACKGROUND: Axillary lymph node staging is vital in breast cancer (BC) management. Sentinel lymph node biopsy (SLNB) reduces complications compared to axillary lymph node dissection (ALND). Recent trials suggest omitting SLNB may be feasible for early-stage patients. This study uses the Surveillance, Epidemiology, and End Results (SEER) database to validate these findings for cT1-2N0M0 patients and explores the relationship between tumor T staging and SLNB. METHODS: We selected BC patients with cT1-2N0M0 stage who underwent breast-conserving surgery (BCS) or BCS + SLNB from the SEER database based on the inclusion and exclusion criteria. Propensity score matching (PSM) was used to balance baseline differences between the two groups. Cox regression analysis was performed to identify independent risk factors for these patients, and Kaplan-Meier (KM) analysis was used to assess survival differences in overall survival (OS) and breast cancer-specific survival (BCSS) between the BCS and BCS + SLNB groups. RESULTS: This study included 1,470 BC patients, with 215 undergoing BCS and 1,255 undergoing BCS + SLNB. The BCS group had less aggressive tumors and was older on average. Cox regression analysis of patients' OS and BCSS showed that SLNB was not an independent risk factor for patients. Before PSM, SLNB was associated with improved OS in patients; however, after PSM, this statistical difference disappeared. Subgroup analysis by T staging also indicated no impact of SLNB on OS or BCSS, supporting the feasibility of omitting SLNB for clinically node-negative (cN0) patients. CONCLUSIONS: This study, using the SEER database, found that SLNB did not impact the prognosis of cT1-2N0M0 BC patients, regardless of T stage. This supports previous findings that these patients may avoid axillary surgery without compromising outcomes.