Axillary lymph node micrometastases decrease triple-negative early breast cancer survival

Abstract

Background:Triple-negative breast cancers (TNBCs) are the most deadly form of breast cancer (BC) subtypes. Axillary lymph node involvement (ALNI) has been described to be prognostic in BC taken as a whole, but its prognostic value in each subtype is unclear. We explored the prognostic impact of ALNI and especially of small size axillary metastases in early TNBCs.Methods:We analysed in this multicentre study all patients treated for early TNBC in 12 French cancer centres. We explored the correlation between clinicopathological data and ALNI, with a specific focus on the dichotomisation between macrometastases and occult metastases, which is defined as the presence of isolated tumour cells or micrometastases. The prognostic value of ALNI both in terms of disease-free survival (DFS) and overall survival (OS) was also explored.Results:We included 1237 TNBC patients. Five-year DFS and OS were 83.7% and 88.5%, respectively. The identified independent prognostic features for DFS were tumour size >20 mm (hazard ratio (HR)=1.86; 95% CI: 1.11–3.10, P=0.018), lymphovascular invasion (HR=1.69; 95% CI: 1.21–2.34, P=0.002) and ALNI both in case of macrometastases (HR=1.97; 95% CI: 1.38–2.81, P<0.0001) and occult metastases (HR=1.72; 95% CI: 1.1–2.71, P=0.019). DFS and OS were similar between tumours with occult metastases and macrometastases. Tumours presenting at least two pejorative features (out of ALNI, lymphovascular invasion and large tumour size) displayed a significantly poorer DFS in both the training set and validation set, independently of chemotherapy administration. Tumours with no more than one of the above-cited pejorative features had a 5-year OS of ⩾90% vs 70% for other cases (P<0.0001).Conclusions:Axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumour cells were identified in lymph nodes. This impact is independent of chemotherapy use.

Integrative 3′ Untranslated Region-Based Model to Identify Patients with Low Risk of Axillary Lymph Node Metastasis in Operable Triple-Negative Breast Cancer

“…First, in this retrospective study, we tested the associations between the integrative 3′UTR‐based model with the LNM status rather than true prediction. To evaluate the performance of the model, the data from an independent TNBC cohort, with much higher proportion of nodal involvement (50.3%) than that in real world (22.8%) , was used in this study. The disparity in baseline LNM rate may introduce heterogeneity and lower the performance of the model.…”

“…Furthermore, as an invasive surgical procedure, SLNB can cause pain, swelling, bruising, and lymphedema at the surgical site and increase the risk of infection and skin or allergic reactions. A previous study conducted in a large cohort from multicenters reported that 77.2% patients with early TNBC had negative lymph node involvement . Thus, most TNBC patients receive overtreatment via axillary surgery, which increases the surgical comorbidity without survival benefit.…”

Role of postmastectomy radiotherapy in early-stage (T1&ndash;2N0&ndash;1M0) triple-negative breast cancer: a systematic review

“…Truong et al49 reported that patients aged <45 years with >25% positive axillary nodes and patients aged ≥45 years with >25% positive axillary nodes, medial tumor location and ER negative were recommended for PMRT in a retrospective analysis including 821 T1–2N1 breast cancer patients. In addition, Houvenaeghel et al50 showed that axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumor cells were identified in lymph nodes. pN0 cases had longer DFS than pN0(i+)/pN1mic51 (isolated tumor cell [,0.2 mm; pN0(i+], micrometastases [,2 mm; pN1mic]) 50.…”

“…In addition, Houvenaeghel et al50 showed that axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumor cells were identified in lymph nodes. pN0 cases had longer DFS than pN0(i+)/pN1mic51 (isolated tumor cell [,0.2 mm; pN0(i+], micrometastases [,2 mm; pN1mic]) 50. What is more, in a subgroup analysis from an article, the authors showed that in patients with a low-risk disease (stages T1–2N0) without PMRT, LVI was the only strong predictor of both LRR and disease recurrence (DR), which causes a significantly higher 5-year LRR rate and 5-year DR rate than those without LVI (Table 3).…”

Construction of an immune-related genes nomogram for the preoperative prediction of axillary lymph node metastasis in triple-negative breast cancer

“…Compared with patients suffering from other breast cancer subtypes, patients with TNBC are more likely to suffer ALN metastasis at the time of initial diagnosis [11]. ALN metastasis is confirmed as the most critical independent risk factor at the time of initial diagnosis of TNBCs [12,13]. Currently, a modified radical mastectomy with ALN dissection is still one of the most effective surgical treatments for patients with local advanced BCs without distant metastasis, especially early-TNBCs [14].…”