Annals of Oncology Advance Access published online on October 29, 2009
Annals of Oncology, doi:10.1093/annonc/mdp453
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Sinusal localization of nodal micrometastases is a prognostic factor in breast cancer
,*
1 Department of Oncology and Hematology, Istituto Clinico Humanitas IRCCS
2 Department of Pathology, Istituto Clinico Humanitas IRCCS, University of Milan School of Medicine, Rozzano (Milano)
3 Breast Unit, Department of Surgery, Humanitas Gavazzeni, Bergamo
4 Unit of Senology, Department of Oncology and Hematology
5 Unit of Thoracic Surgery
6 Medical Statistics Office, Istituto Clinico Humanitas IRCCS, Rozzano (Milano), Italy
* Correspondence to: Dr G. Masci, Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni, 56, 20089 Rozzano, Milan, Italy. Tel: +39-02-8224-4671; Fax: +39-02-8224-4590; E-mail: giovanna.masci{at}humanitas.it
Background: Breast cancer micrometastases are frequently found during pathological examination of sentinel lymph nodes and complete axillary lymph node dissection. Despite this, their clinical relevance is still debated. The aim of this study is to investigate features that affect disease-free survival (DFS) and overall survival (OS) in patients with nodal micrometastases from breast cancer.
Material and methods: We retrospectively investigated the outcome of 122 patients with nodal micrometastases from breast cancer followed up for 60 months.
Results: At univariate analysis, worse DFS was related to features of primary tumor (multifocality P = 0.002; size >2 cm, P = 0.022; grade P = 0.022; absence of estrogen P < 0.001 and progesterone P < 0.001 receptors; HER-2 overexpression P = 0.006; vascular invasion P = 0.039; proliferative fraction 
20% P = 0.034) and micrometastases (sinusal localization P = 0.010). Among the above-mentioned features, two were strongly associated with worse DFS in the multivariate model, i.e. negative receptorial status [hazard ratio (HR) = 11.24, 95% confidence interval (CI) 4.06–31.09; P < 0.001] and sinusal localization of micrometastasis (HR = 3.66, 1.18–11.36; P = 0.025). The OS was influenced by multifocality (P < 0.001) and receptor status (P = 0.005).
Conclusion: Our results indicate that in patients affected by breast cancer, in addition to the well-known pathological features of primary tumor, sinusal localization of micrometastasis strongly impacts on the prognosis.
breast, cancer, lymph node, micrometastasis, prognosis
Both authors contributed equally as senior authors Received for publication July 31, 2009. Accepted for publication August 7, 2009.