Prognostic Value of Lymph Node Micrometastases in Breast Cancer: A Multicenter Cohort Study

Abstract

BackgroundTo evaluate the prognostic meaning of lymph node micrometastases in breast cancer patients.MethodsBetween January 2000 and January 2003, 1411 patients with a cT1-2N0 invasive breast carcinoma underwent surgery in 7 hospitals in the Netherlands. Sentinel lymph node biopsy was done in all patients. Based on lymph node status, patients were divided into 4 groups: pN0 (n = 922), pN1micro (n = 103), pN1a (n = 285), and pN≥1b (n = 101). Median follow-up was 6.4 years.ResultsAt the end of follow-up, 1121 women were still alive (79.4%), 184 had died (13.0%), and 106 were lost to follow-up (7.5%). Breast cancer recurred in 244 patients: distant metastasis (n = 165), locoregional relapse (n = 83), and contralateral breast cancer (n = 44). Following adjustment for possible confounding characteristics and for adjuvant systemic treatment, overall survival (OS) remained comparable for pN0 and pN1micro and was significantly worse for pN1a and pN≥1b (hazard ratio [HR] 1.18; 95% confidence interval [95% CI] 0.58–2.39, HR 2.47; 95% CI 1.69–3.63, HR 4.36; 95% CI 2.70–7.04, respectively). Disease-free survival (DFS) was similar too in the pN0 and pN1micro group, and worse for pN1a and pN≥1b (HR 0.96; 95% CI 0.56–1.67 vs HR 1.64; 95% CI 1.19–2.27, HR 2.95; CI 1.98–4.42). The distant metastases rate also did not differ significantly between the pN0 and pN1micro group and was worse for pN1a and pN≥1b (HR 1.22; 95% CI 0.60–2.49, HR 2.26; 95% CI 1.49–3.40, HR 3.49; CI 2.12–5.77).ConclusionsIn breast cancer patients survival is not affected by the presence of micrometastatic lymph node involvement.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-010-1451-z) contains supplementary material, which is available to authorized users.

Microscopic N2 disease exhibits a better prognosis in resected non-small-cell lung cancer

“…On the other hand, in other cancers, microscopic N is emerging as a prognostic factor. In particular, in a large multicentre study on breast cancer, the authors reported that the presence of microscopic axillary metastases had no impact on both OS and disease-free survival (DFS) compared with patients without lymph node metastases [10]. However, so far, the prognostic impact of microscopic N on NSCLC is unknown.…”

Comparing the Detection of Lymph Nodes Micrometastasis in Breast Cancer by the Hematoxylin and Eosin Staining Method (H&E) and the Immunohistochemical Method (IHC)

“…The difference between tumor size in both positive and negative groups was not significant that was similar to other studies (10)(11)(12), but non-aligned with the study conducted by Dabbs et al (14), which reported that by increasing the tumor size, the rate of micrometastasis increased. Also, in a study conducted by Gobardhan et al (15), it was shown that by increasing the tumor size, micrometastasis decreased and macrometastasis increased. However, this difference could be due to the small sample size studied by our study.…”

Czy można odstąpić od limfadenektomii pachowej przy przerzutach do węzła chłonnego wartowniczego?

“…Przeprowadzona analiza nie wykazała różnic w przeżyciach chorych z grup N0 i N1(mi) (ryc. 4) [10]. Podobne wyniki osiągnęli autorzy innego badania [11].…”

“…Przeglądając piśmien-nictwo znalazłem ponad 60 prac dotyczących znaczenia rokowniczego mikroprzerzerzutów do WW w raku piersi. Część autorów uważa, że mikroprzerzuty nie mają znaczenia rokowniczego [15][16][17], inni zaś twierdzą, że mikroprzerzuty mają znaczenie rokownicze, i snują wnioski dotyczące konieczności uzupełniającego leczenia systemowego u tych kobiet [18][19][20][21]. Ale w żadnej z prac nie znalazłem zalecenia, że w przypadku stwierdzenia mikroprzerzutów do WW konieczna jest limfadenektomia pachowa.…”