Reevaluating sentinel lymph node biopsy in older adults with T1 HR+/HER2- breast cancer: a SEER competing risk and nomogram study.

Authors

Ziqiang Wang, Yangyang Xie, Weijun Zhang, Xue Song, Qiwei Du, Nian Liu, Rongguo Li, Lanlan Gao

Published in

Breast cancer (Tokyo, Japan). Jul 23, 2026. Epub Jul 23, 2026.

Abstract

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging. However, its necessity in older patients (≥ 70 years) with HR+/HER2- T1 breast cancer remains debated in the context of contemporary de-escalation strategies. Existing evidence often incompletely accounts for the competing risk of death in this population. We evaluated the association between SLNB and breast cancer-specific death (BCSD) using real-world data.
Women aged ≥ 70 years with HR+/HER2- T1 (≤ 20 mm) breast cancer treated with breast-conserving surgery between 2010 and 2021 were identified from the SEER database and classified into SLNB and No-SLNB groups. Propensity score matching (PSM) and Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs) for BCSD and other-cause death (OCD). A prognostic nomogram was constructed.
Among 47,838 eligible patients, 37,732 underwent SLNB and 10,106 did not. After PSM, SLNB was associated with a lower 5-year cumulative incidence of BCSD (2.50% vs. 3.50%); differences in OCD were also observed. In multivariable competing risk analysis, SLNB remained independently associated with reduced BCSD (sHR 0.69, 95% CI 0.60-0.80). The association was most pronounced in patients aged ≥ 80 years and those with T1c (11-20 mm) tumors, whereas the absolute risk difference was minimal in the 1-5 mm subgroup. The nomogram showed good discrimination (time-dependent AUC up to 0.821 in the training set and 0.857 in the validation set) and calibration.
In this real-world cohort, SLNB was associated with lower BCSD in older adults with HR+/HER2- T1 breast cancer, particularly in those aged ≥ 80 years or with T1c tumors. While the incremental value of SLNB appears limited in ultra-low-risk groups, age alone should not dictate omission of axillary staging. The nomogram may support individualized decision-making.

PMID:
42489813
Bibliographic data and abstract were imported from PubMed on 23 Jul 2026.

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