Association between sentinel lymph node number and prognosis in cT1-2N0M0 early breast cancer patients with negative sentinel lymph nodes: a single‑center retrospective cohort study

Why clinicians should know about it

• Picked for Breast and Endocrine Surgery (paper of the day, 20 August 2026): Sentinel lymph node number and prognosis in early breast cancer

Abstract

BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for cN0 breast cancer, but the prognostic impact of the number of excised sentinel lymph nodes (SLNs) remains unclear. OBJECTIVE: To evaluate the association between SLN excision number and long‑term prognosis, short‑term axillary complications, and changes in hematological immune parameters in early‑stage breast cancer patients with negative SLNs. METHODS: TWe retrospectively included cT1-2N0M0 breast cancer patients treated at our institution (2012-2019) with negative SLNs. Patients were grouped by number of SLNs excised: 1-3, 4-6, and ≥7. The primary outcome was 5‑year disease‑free survival (DFS); secondary outcomes included overall survival (OS), axillary complications (lymphedema, mobility/strength limitations), and changes in immune parameters (NLR, PLR, LMR, SII, SIRI). Multivariable Cox and logistic regression analyses were performed. RESULTS: Among 1551 patients, 5-year DFS events occurred in 82 (5.3%) and OS events in 39 (2.5%). Axillary complications were reported in 5.9% (lymphedema), 4.8% (strength limitation), and 2.5% (mobility limitation). After multivariate adjustment, SLN excision number was not significantly associated with DFS (≥7 vs. 1-3: HR=1.02, p = 0.95) or OS (HR=0.91, p = 0.86). Logistic regression showed no significant associations with axillary recurrence or complications. Among immune parameters, only the change in neutrophil-to-lymphocyte ratio (ΔNLR) differed significantly between groups (p = 0.02). CONCLUSION: In this retrospective negative‑SLN cohort, the number of SLNs excised was not significantly associated with 5‑year survival or short‑term axillary complications, suggesting that removing 1-3 SLNs may be sufficient in this patient population.

Abstract as published, via PubMed.