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Breast Cancer Survival in Relation to the Metastatic Tumor Burden in Axillary Lymph Nodes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
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2010 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 28, no 17, 2868-2873 p.Article in journal (Refereed) Published
Abstract [en]

Purpose The aim of this study was to determine the prognostic significance of lymph node micrometastases in patients with breast cancer. Patients and Methods Between September 2000 and January 2004, 3,369 patients with breast cancer were included in a prospective cohort. According to their lymph node status, they were classified in the following four groups: 2,383 were node negative, 107 had isolated tumor cells, 123 had micrometastases, and 756 had macrometastases. Median follow-up time was 52 months. Kaplan-Meier estimates and the multivariate Cox proportional hazard regression model were used to analyze survival. Results Five-year cause-specific and event-free survival rates were lower for patients with micrometastases (pN1mi) than for node-negative (pN0) patients (94.1% v 96.9% and 79.6% v 87.1%, respectively; P = .020 and P = .032, respectively). There was no significant survival difference between node-negative patients and those with isolated tumor cells. The overall survival of pN1mi and pN0 patients did not differ. Conclusion This study demonstrates a worse prognosis for patients with micrometastases than for node-negative patients.

Place, publisher, year, edition, pages
2010. Vol. 28, no 17, 2868-2873 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-135559DOI: 10.1200/JCO.2009.24.5001ISI: 000278548000010OAI: oai:DiVA.org:uu-135559DiVA: diva2:377590
Available from: 2010-12-14 Created: 2010-12-07 Last updated: 2012-08-01Bibliographically approved
In thesis
1. Sentinel Node in Clinical Practice: Implications for Breast Cancer Treatment and Prognosis
Open this publication in new window or tab >>Sentinel Node in Clinical Practice: Implications for Breast Cancer Treatment and Prognosis
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The introduction of sentinel lymph node biopsy (SLNB) has conveyed several new issues, such as the risk of false negativity, long-term consequences, the prognostic significance of micrometastases and whether ALND can be omitted in sentinel lymph node- (SLN) positive patients.

Archived SLN specimens from 50 false negative patients and 107 true negative controls were serially sectioned and stained with immunohistochemistry. The detection rate of previously unknown metastases did not differ between the false and the true negative patients. The risk of false negativity was higher in patients with multifocal or hormone receptor-negative tumours, or if only one SLN was found.

In a Swedish multicentre cohort, 2216 SLN-negative patients in whom ALND was omitted were followed up for a median of 65 months. The isolated axillary recurrence rate was only 1.0%, and the overall survival was high (93%).

The survival of 3369 breast cancer patients (2383 node-negative (pN0), 107 isolated tumour cells (pN0(i+), 123 micrometastases (pN1mi) and 756 macrometastases (pN1)) was analysed. The 5-year cause-specific and event-free survival was worse for pN1mi and pN1 patients than for pN0 patients. There was no difference in survival between pN0(i+) and pN0 patients.

Tumour and SLN characteristics in 869 SLN-positive patients were compared between those with and without non-SLN metastases, and the Tenon score was calculated. The risk of non-SLN metastases was higher in case of SLN macrometastases (compared with micrometastases), a high positive/total SLN ratio and Elston grade 3 tumours, and increased with increasing tumour size. The area under the curve (AUC) for the Tenon score was 0.65, and the test thus performed inadequately in this population.

In conclusion, despite the risk of false negativity, SLNB with omission of ALND in SLN-negative patients appears to be safe even in the long term. The presence of micrometastases is of prognostic importance and should entail adjuvant treatment. The need for ALND in patients with SLN micro- and even macrometastases has been questioned, but the occurrence of non-SLN metastases is hard to predict, and strong evidence for the safe omission of ALND is lacking.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 55 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 754
breast cancer, sentinel node, micrometastases, survival, non-sentinel node metastases
National Category
urn:nbn:se:uu:diva-171078 (URN)978-91-554-8316-6 (ISBN)
Public defence
2012-05-12, Aulan, Ingång 21, Västmanlands Sjukhus, Västerås, 09:15 (English)
Available from: 2012-04-20 Created: 2012-03-15 Last updated: 2012-08-01Bibliographically approved

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