Annals of Oncology Advance Access originally published online on July 24, 2008
Annals of Oncology 2009 20(1):41-48; doi:10.1093/annonc/mdn535
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breast cancer |
Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
2 Department of Nuclear Medicine, Diakonessenhuis Utrecht
3 Department of Pathology, Diakonessenhuis Utrecht, The Netherlands
4 Department of Surgery, Diakonessenhuis Utrecht
* Correspondence to: Dr T. van Dalen, Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands. Tel: +31-30-2566225; Fax: +31-30-2566210; E-mail: tvdalen{at}diakhuis.nl
Background: The prognostic meaning and thus indication for adjuvant therapy of lymphogenic micrometastases in breast cancer patients is still under debate.
Patients and methods: From 1999 to 2007, 703 patients with cT1–2N0 breast cancer underwent surgery including sentinel lymph node biopsy. Examination of sentinel lymph nodes consisted of hematoxylin and eosin and immunohistochemistry staining following serial sectioning of the sentinel node. Patients were divided into four groups: pN0 (n = 423), pN1micro (n = 81), pN1a (n = 130) and pN
1b (n = 69). Median follow-up was 40 months.
Results: At the end of follow-up, 53 patients had died and 64 had recurrent disease. Compared with pN0 and following adjustment for possible confounders, including adjuvant systemic treatment, overall survival was not significantly different for pN1micro while significantly worse for pN1a and pN1b {hazard ratio (HR) [95% confidence interval (CI)]: 0.59 [0.14–2.58], 4.31 [1.85–10.01], 10.66 [4.04–28.14], respectively}. Likewise, disease-free survival was not significantly different for pN1micro and worse for pN1a and pN1b (HR [95% CI]: 1.43 [0.67–3.02], 2.79 [1.37–5.66], 7.13 [3.27–15.54], respectively). Distant metastases were more commonly observed in the pN1micro than in the pN0 group, but still not as common as in the pN1a or pN1b group (HR [95% CI]: 4.85 [1.79–13.18], 10.34 [3.82–28.00], 23.25 [7.88–68.56], respectively).
Conclusion: Although the risk of distant metastases was higher in patients in the pN1micro than in the pN0 group, no statistically significant differences were observed in overall or disease-free survival between pN0 and pN1micro. Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients.
Key words: breast cancer, micrometastases, prognosis, sentinel lymph node
Received for publication March 11, 2008. Revision received June 25, 2008. Accepted for publication July 1, 2008.
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