title: Omission of axillary staging in elderly patients with early stage breast cancer impacts regional control but not survival: A systematic review and meta-analysis.
abstract: Management of early breast cancer in the elderly population is challenging due to different breast cancer biology and limited tolerance to aggressive treatments. The aim of this study is to evaluate whether the omission of axillary staging impacts breast cancer outcomes in elderly patients.
  
  
  
  A systematic review and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The electronic databases were searched in August 2014 using the following inclusion criteria: RESULTS: Two RCTs met the eligibility criteria and were included. A meta-analysis of the included RCTs of 692 patients found that axillary staging reduced the risk of axillary recurrence compared to no axillary staging (RR 0.24, 95% CI: 0.06 to 0.95, I2=0%, p=0.04). There were no differences observed in in-breast recurrence or distant recurrence (RR 1.20, 95% CI: 0.55 to 2.64, I2=62%, p=0.65, RR 1.17, 95% CI: 0.75 to 1.82, I2=0%, p=0.48, respectively). There were no differences observed in overall or breast-cancer specific mortality (RR 0.99, 95% CI: 0.79 to 1.24, I2=0%, p=0.92, RR 1.07, 95% CI: 0.72 to 1.57, I2=0%, p=0.75, respectively).
  
  
  
  Omission of axillary staging in elderly patients with clinically negative axillae results in increased regional recurrence but does not appear to impact survival.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, 500 University Avenue, Suite 602, Toronto, Ontario M5G 1V7, Canada.
authors.forename: Shuyin
authors.initials: S
authors.lastname: Liang
authors.affiliation: Department of Surgery, University of Toronto, Toronto, 500 University Avenue, Suite 602, Toronto, Ontario M5G 1V7, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Hallet
authors.affiliation: Department of Surgery, University of Toronto, Toronto, 500 University Avenue, Suite 602, Toronto, Ontario M5G 1V7, Canada; Division of General Surgery, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B1W8, Canada.
authors.forename: Jory S
authors.initials: JS
authors.lastname: Simpson
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B1W8, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
authors.affiliation: Department of Surgery, University of Toronto, Toronto, 500 University Avenue, Suite 602, Toronto, Ontario M5G 1V7, Canada; Division of General Surgery, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B1W8, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B1W8, Canada. Electronic address: scheera@smh.ca.
authors.forename: Adena S
authors.initials: AS
authors.lastname: Scheer
mesh_terms: D000367:Age Factors; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D055088:Early Detection of Cancer / Q000401:mortality*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome
keywords: Axillary staging; Breast cancer; Elderly; Meta-analysis; Systematic review