Hong Pan1,2, Hui Wang1,2, Mengjia Qian1,2, Xinrui Mao1,2, Guojian Shi3,4, Ge Ma1,2, Muxin Yu1,2, Hui Xie1,2, Lijun Ling1,2, Qiang Ding1,2, Kai Zhang5,6, Shui Wang1,2, Wenbin Zhou1,2. 1. Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China. 2. Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China. 3. Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China. 4. Department of Thyroid and Breast Surgery, The Second People's Hospital of Kunshan, Suzhou, China. 5. Pancreatic Center & Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China. 6. Pancreas Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
Abstract
Importance: There is a lack of studies exploring whether the survival of patients with distant lymph node metastases (DLNM) is different from that of patients with ipsilateral supraclavicular lymph node metastases (ISLM) and other stage IV breast cancer. Objective: To assess the survival of patients with DLNM from breast cancer vs ISLM and other stage IV breast cancer. Design, Setting, and Participants: This cohort study included 2033 patients diagnosed with breast cancer between January 1, 2010, and December 31, 2014, from the Surveillance, Epidemiology and End Results registries database. Three groups of patients were included: (1) patients with ISLM without any distant metastasis, (2) patients with DLNM, and (3) patients with distant metastases (DLNM excluded). Patients younger than 18 years or older than 100 years were excluded. The data were analyzed in February 2020. Exposures: Surgery for primary tumor, surgery for distant lymph nodes, and radiotherapy. Main Outcomes and Measures: Overall survival (OS) and breast cancer-specific survival (BCSS). Results: Of the 2033 women (mean [SD] age, 62.03 [14.62] years [range, 23.00-99.00 years]; 1510 White participants [74.3%]) with breast cancer included in the study, 346 patients (17.0%) had DLNM, 212 (10.4%) had ISLM, and 1475 (72.6%) had distant metastases (DLNM excluded). The 3-year BCSS rates were 63.24% for ISLM, 64.54% for DLNM, and 41.20% for distant metastases. The 3-year OS rates were 53.46% for ISLM, 62.67% for DLNM, and 38.21% for distant metastases. Compared with patients with ISLM, patients with DLNM showed similar BCSS (hazard ratio [HR], 0.81; 95% CI, 0.52-1.25; P = .34) and OS (HR, 0.73; 95% CI, 0.51-1.05; P = .09), whereas patients with distant metastases showed significantly poorer BCSS (HR, 1.99; 95% CI, 1.43-2.78; P < .001) and OS (HR, 1.79; 95% CI, 1.35-2.38; P < .001). Of the 346 patients with DLNM, primary surgery (HR, 0.21; 95% CI, 0.12-0.39; P < .001) and radiotherapy (HR, 0.46; 95% CI, 0.25-0.87; P = .02) were significantly associated with improved OS. Conclusions and Relevance: The results of this cohort study suggest that DLNM of breast cancer, with similar survival to N3c disease (indicating metastases to the ipsilateral supraclavicular lymph nodes), might be a regional disease, and reassessment of the role of lymph node metastases in breast cancer may be necessary. Given these findings, aggressive locoregional therapies for this disease are recommended, although future studies are still needed to confirm these results.
Importance: There is a lack of studies exploring whether the survival of patients with distant lymph node metastases (DLNM) is different from that of patients with ipsilateral supraclavicular lymph node metastases (ISLM) and other stage IV breast cancer. Objective: To assess the survival of patients with DLNM from breast cancer vs ISLM and other stage IV breast cancer. Design, Setting, and Participants: This cohort study included 2033 patients diagnosed with breast cancer between January 1, 2010, and December 31, 2014, from the Surveillance, Epidemiology and End Results registries database. Three groups of patients were included: (1) patients with ISLM without any distant metastasis, (2) patients with DLNM, and (3) patients with distant metastases (DLNM excluded). Patients younger than 18 years or older than 100 years were excluded. The data were analyzed in February 2020. Exposures: Surgery for primary tumor, surgery for distant lymph nodes, and radiotherapy. Main Outcomes and Measures: Overall survival (OS) and breast cancer-specific survival (BCSS). Results: Of the 2033 women (mean [SD] age, 62.03 [14.62] years [range, 23.00-99.00 years]; 1510 White participants [74.3%]) with breast cancer included in the study, 346 patients (17.0%) had DLNM, 212 (10.4%) had ISLM, and 1475 (72.6%) had distant metastases (DLNM excluded). The 3-year BCSS rates were 63.24% for ISLM, 64.54% for DLNM, and 41.20% for distant metastases. The 3-year OS rates were 53.46% for ISLM, 62.67% for DLNM, and 38.21% for distant metastases. Compared with patients with ISLM, patients with DLNM showed similar BCSS (hazard ratio [HR], 0.81; 95% CI, 0.52-1.25; P = .34) and OS (HR, 0.73; 95% CI, 0.51-1.05; P = .09), whereas patients with distant metastases showed significantly poorer BCSS (HR, 1.99; 95% CI, 1.43-2.78; P < .001) and OS (HR, 1.79; 95% CI, 1.35-2.38; P < .001). Of the 346 patients with DLNM, primary surgery (HR, 0.21; 95% CI, 0.12-0.39; P < .001) and radiotherapy (HR, 0.46; 95% CI, 0.25-0.87; P = .02) were significantly associated with improved OS. Conclusions and Relevance: The results of this cohort study suggest that DLNM of breast cancer, with similar survival to N3c disease (indicating metastases to the ipsilateral supraclavicular lymph nodes), might be a regional disease, and reassessment of the role of lymph node metastases in breast cancer may be necessary. Given these findings, aggressive locoregional therapies for this disease are recommended, although future studies are still needed to confirm these results.
Authors: Bernard Fisher; Jong-Hyeon Jeong; Stewart Anderson; John Bryant; Edwin R Fisher; Norman Wolmark Journal: N Engl J Med Date: 2002-08-22 Impact factor: 91.245
Authors: L Gerratana; V Fanotto; M Bonotto; S Bolzonello; A M Minisini; G Fasola; F Puglisi Journal: Clin Exp Metastasis Date: 2015-01-29 Impact factor: 5.150
Authors: Wadih Arap; Mikhail G Kolonin; Martin Trepel; Johanna Lahdenranta; Marina Cardó-Vila; Ricardo J Giordano; Paul J Mintz; Peter U Ardelt; Virginia J Yao; Claudia I Vidal; Limor Chen; Anne Flamm; Heli Valtanen; Lisa M Weavind; Marshall E Hicks; Raphael E Pollock; Gregory H Botz; Corazon D Bucana; Erkki Koivunen; Dolores Cahill; Patricia Troncoso; Keith A Baggerly; Rebecca D Pentz; Kim-Anh Do; Christopher J Logothetis; Renata Pasqualini Journal: Nat Med Date: 2002-02 Impact factor: 53.440
Authors: Ethel R Pereira; Dmitriy Kedrin; Giorgio Seano; Olivia Gautier; Eelco F J Meijer; Dennis Jones; Shan-Min Chin; Shuji Kitahara; Echoe M Bouta; Jonathan Chang; Elizabeth Beech; Han-Sin Jeong; Michael C Carroll; Alphonse G Taghian; Timothy P Padera Journal: Science Date: 2018-03-22 Impact factor: 47.728