Erratum: Axillary Surgery vs Non-Axillary Staging in T1N0 Breast Cancer

Overview

This erratum corrects key sentences in the abstract of the INT 09/98 randomized clinical trial comparing axillary surgery and no-axillary staging in T1N0 breast cancer with 20-year follow-up. The corrections clarify the evolving role of axillary surgery, the interpretation of axillary relapse rates with distant metastases, and the prognosis of biologically aggressive subgroups.

Background

Axillary surgery in breast cancer has transitioned from a therapeutic procedure to primarily a staging method guiding adjuvant therapy decisions, with sentinel lymph node biopsy becoming standard. The INT 09/98 trial investigated outcomes of axillary surgery versus no-axillary staging in patients with T1N0 breast cancer over two decades. Understanding the long-term impact of these approaches is critical for optimizing treatment strategies and prognostication.

Data Highlights

The erratum does not present new numerical data but revises interpretative statements regarding axillary relapse rates and distant metastases observed in the trial arms.

Key Findings

• The role of axillary surgery has shifted from therapeutic to staging for adjuvant therapy, leading to sentinel lymph node biopsy adoption.
• The high incidence of distant metastases in patients with axillary recurrence may indicate aggressive tumor biology.
• The rate of axillary relapse with distant metastases was similar to that in patients with positive nodes at primary surgery in the QUAD arm.
• Patients with axillary recurrence in the QU arm and those with baseline axillary involvement in the QUAD arm who developed distant metastases likely represent a biologically aggressive subgroup.
• This subgroup's poorer prognosis appears genomically determined and independent of surgical or adjuvant treatments.

Clinical Implications

Clinicians should recognize that axillary relapse accompanied by distant metastases may signify an inherently aggressive tumor biology rather than failure of surgical or adjuvant interventions. The findings support the continued use of sentinel lymph node biopsy for staging while highlighting the need for genomic profiling to identify high-risk patients who may benefit from tailored systemic therapies.

Conclusion

The corrected abstract emphasizes that axillary surgery's role is primarily staging, and that axillary relapse with distant metastases identifies a biologically aggressive breast cancer subgroup with poor prognosis independent of treatment modality.

References

1. Agresti et al. 2025 -- Axillary surgery versus no-axillary staging in T1N0 breast cancer: 20-year follow-up of the INT 09/98 randomized clinical trial