Breast Cancer Survival According to Number of Nodes Removed

Abstract

Background:Results from randomized trials indicate a 5.4% survival advantage associated with axillary dissection. To gain insight on survival outcomes when less than an axillary dissection is performed, we performed a retrospective analysis to determine survival outcome for node-negative and node-positive breast cancer patients when a variable number of nodes were excised.Methods: The data analyzed in this paper are from the Surveillance, Epidemiology, and End Results (SEER) database, from which 72,102 patients were selected whose breast cancer had been diagnosed in 1988 or later and who were aged 40 -79 years at diagnosis, had a single primary lesion, and had 0 to 3 positive lymph nodes. Cases were separated into age groups (40 to 49 and 50 to 79 years), and node-negative cases were separated from those with one to three positive nodes.Results: This analysis indicates that even when all regional lymph nodes are pathologically negative, the number of nodes removed is associated with survival. In the group of breast cancer patients who had one to three pathologically positive nodes, as with the node-negative group, the higher the number of nodes removed, the greater the survival. The hazard rate for death in the node-negative group was roughly 5% less for each additional five nodes removed. For the node-positive group, the hazard rate for death was between 8% and 9% less for each additional five nodes removed.Conclusions: This retrospective study supports the notion that removal of regional nodes, even when such nodes are interpreted as pathologically negative, is important for the long-term survival of breast cancer patients.

Prognostic impact of lymphadenectomy in uterine serous cancer

“…[40][41][42][43][44][45] In an analysis of 12 333 women diagnosed with endometrioid endometrial cancer using SEER data, a more extensive lymph node resection was associated with improved survival in intermediate/high-risk patients. 46 Our data suggest that a more extensive lymphadenectomy is associated with an improved 5-year survival in USC.…”

Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph node-positive breast cancer

“…Although the number of ALN involved with cancer has been demonstrated to be important for prognosis and is included in the 6th edition of the AJCC BC staging system, the role of the total number of ALN retrieved in an ALND specimen has received less emphasis.20-24 This is despite data that clearly suggest that the likelihood of finding positive nodes in the axilla increases with the number of nodes dissected, and the likelihood of having residual disease in the axilla decreases with a more extensive dissection. 11,25 In an attempt to address the above, several studies have focused on the utility of the ALNR as an independent prognostic indicator of OS.…”

Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

“…[20][21][22][23][24] This is despite data that clearly suggest that the likelihood of finding positive nodes in the axilla increases with the number of nodes dissected, and the likelihood of having residual disease in the axilla decreases with a more extensive dissection. 11,25 In an attempt to address the above, several studies have focused on the utility of the ALNR as an independent prognostic indicator of OS. [12][13][14][15][16][17][18] Our study demonstrates a statistically significant negative correlation between ALNR and OS, thus supporting the findings of previous studies (Table 5).…”

“…This classification improved stratification in OS, but the confounding effect that the number of excised nodes may have on the yield of positive nodes and its effect on BC-specific survival prognostic accuracy and management decisions are problems that remain unresolved. 6,11 Thus, the ratio between the number of pALN and the total number of excised nodes, or the axillary lymph node ratio (ALNR), may be a more comprehensive approach to estimate prognosis because it takes into account the number of excised nodes and may accordingly adjust for differences in nodal staging.…”