Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update

Abstract

The current findings completely affirm the validity of our original observations indicating the appropriateness of grouping primary breast cancer patients into those with negative, 1 to 3, or ≫4 positive nodes. Results, however, reveal that there is a risk in combining all patients with ≫4 positive nodes into a single group. Since there was a 25% greater disease‐free survival and an 18% greater survival in those with 4 to 6 than in those with ≫13 positive axillary nodes, such a unification may provide misleading information regarding patient prognosis, as well as the worth of a therapeutic regimen when compared with another from a putatively similar patient population. Of particular interest were findings relating the conditional probability, i.e., the hazard rate, of a treatment failure or death each year during the 5‐year period following operation to nodal involvement with tumor. Whereas the hazard rate for those with negative, or 1 to 3 positive nodes, was relatively low and constant, in those with ≫4 positive nodes the risk in the early years was much greater, but by the fifth year it was similar to that occurring when 1‐3 nodes were involved, and not much different from negative node patients. The same pattern existed whether 4 to 6 or ≫13 nodes were positive. When the current findings are considered relative to other factors with predictive import, it is concluded that nodal status still remains the primary prognostic discriminant.

A comparison of axillary node status between cancers detected at the prevalence and first incidence breast screening rounds

“…Their relationship between size and lymph node status seen for PS-and FIS-detected cancers is similar to that seen between screen-detected and symptomatic cancers, with the latter having a higher incidence of nodal involvement (Crisp et al, 1993). Moreover, the frequency of node metastases in the FIS-detected cancers is equivalent to that seen in a symptomatic breast cancer population (Fisher et al, 1983).…”

Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

“…Patients with lymph node involvement have an increased risk of disease recurrence and reduced overall survival. 1 However, the recurrence rate in patients that are axillary lymph node-negative ranges from 16% to 40%. [2][3][4] Lymphovascular invasion (LVI), as shown by the presence of tumor cells in blood vessels and/or lymphatic channels, is a required histopathological finding in assessment of primary breast tumors.…”

Detection of metastases in sentinel lymph nodes of breast cancer patients by multiple mRNA markers

“…Involvement of lymph nodes and the number of lymph nodes harbouring metastases at primary diagnosis have an inverse relationship with the disease prognosis, meaning that patients with lymph nodes free of metastases have a better outcome (Fisher et al, 1983;Carter et al, 1989;Hellman, 1994;Quiet et al, 1995;Saimura et al, 1999). However, 20 -30% of node-negative patients will develop a relapse in 5 -10 years after diagnosis (Kamby et al, 1991;Hellman, 1994).…”