Roi Weiser1, Efstathia Polychronopoulou2, Waqar Haque3, Sandra S Hatch4, Jing He5, Suimin Qiu5, Avi Markowitz6, William J Gradishar7, Yong-Fang Kuo2, V Suzanne Klimberg8,9. 1. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. roiweiser@yahoo.com. 2. Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA. 3. Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA. 4. Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA. 5. Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA. 6. Division of Hematology/Oncology, University of Texas Medical Branch, Galveston, TX, USA. 7. Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 8. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. vsklimbe@utmb.edu. 9. MD Anderson Cancer Center, Houston, TX, USA. vsklimbe@utmb.edu.
Abstract
BACKGROUND: The number of involved lymph nodes negatively affects prognosis in breast cancer patients. Nevertheless, current staging and treatment recommendations do not distinguish between patients with single versus multiple lymphatic micrometastases. In this study, we aim to better characterize these patients. METHODS: The National Cancer Database was retrospectively queried to identify 486,800 women with stage I-III, estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative (ER+/PR+/HER2-) breast cancer and nodal status of N0, N1mi with 1 (Nmic1) or more (Nmic > 1) involved nodes, and N1 with 1 involved node (N1.1), from 2010 to 2016. Patients with different nodal statuses were compared regarding treatment characteristics, survival, and benefit from chemotherapy by their 21-gene recurrence score (RS). RESULTS: Of the 23,072 N1mi patients, 88.3% were Nmic1 and 11.7% were Nmic > 1. Nmic > 1 patients were younger, had larger and higher-grade tumors, with more lymphovascular invasion, and were more commonly treated by axillary dissection, radiation, and chemotherapy than Nmic1 patients. In that, they were comparable with N1.1 patients. Five-year survival of Nmic > 1 patients (88.1%) was worse than Nmic1 patients (90.1%; p = 0.02), but similar to N1.1 patients (87.9%). Nmic1, Nmic > 1, and N1.1 patients with RS 11-25 exhibited a < 2% absolute survival benefit associated with chemotherapy. With RS > 25, Nmic > 1 patients showed a 3.5% benefit, similar to Nmic1 (4.8%) and lower than N1.1 (10.9%) patients. CONCLUSIONS: Nmic > 1 breast cancer patients have worse prognoses than Nmic1 patients, similar to N1.1 patients. Our data suggest those patients with RS 11-25 have minimal benefit from chemotherapy. These findings should be taken into account when discussing prognosis and considering chemotherapy in patients with lymphatic micrometastases.
BACKGROUND: The number of involved lymph nodes negatively affects prognosis in breast cancerpatients. Nevertheless, current staging and treatment recommendations do not distinguish between patients with single versus multiple lymphatic micrometastases. In this study, we aim to better characterize these patients. METHODS: The National Cancer Database was retrospectively queried to identify 486,800 women with stage I-III, estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative (ER+/PR+/HER2-) breast cancer and nodal status of N0, N1mi with 1 (Nmic1) or more (Nmic > 1) involved nodes, and N1 with 1 involved node (N1.1), from 2010 to 2016. Patients with different nodal statuses were compared regarding treatment characteristics, survival, and benefit from chemotherapy by their 21-gene recurrence score (RS). RESULTS: Of the 23,072 N1mi patients, 88.3% were Nmic1 and 11.7% were Nmic > 1. Nmic > 1 patients were younger, had larger and higher-grade tumors, with more lymphovascular invasion, and were more commonly treated by axillary dissection, radiation, and chemotherapy than Nmic1 patients. In that, they were comparable with N1.1 patients. Five-year survival of Nmic > 1 patients (88.1%) was worse than Nmic1 patients (90.1%; p = 0.02), but similar to N1.1 patients (87.9%). Nmic1, Nmic > 1, and N1.1 patients with RS 11-25 exhibited a < 2% absolute survival benefit associated with chemotherapy. With RS > 25, Nmic > 1 patients showed a 3.5% benefit, similar to Nmic1 (4.8%) and lower than N1.1 (10.9%) patients. CONCLUSIONS: Nmic > 1 breast cancerpatients have worse prognoses than Nmic1 patients, similar to N1.1 patients. Our data suggest those patients with RS 11-25 have minimal benefit from chemotherapy. These findings should be taken into account when discussing prognosis and considering chemotherapy in patients with lymphatic micrometastases.
Authors: S Eva Singletary; Craig Allred; Pandora Ashley; Lawrence W Bassett; Donald Berry; Kirby I Bland; Patrick I Borgen; Gary Clark; Stephen B Edge; Daniel F Hayes; Lorie L Hughes; Robert V P Hutter; Monica Morrow; David L Page; Abram Recht; Richard L Theriault; Ann Thor; Donald L Weaver; H Samuel Wieand; Frederick L Greene Journal: J Clin Oncol Date: 2002-09-01 Impact factor: 44.544
Authors: Maaike de Boer; Carolien H M van Deurzen; Jos A A M van Dijck; George F Borm; Paul J van Diest; Eddy M M Adang; Johan W R Nortier; Emiel J T Rutgers; Caroline Seynaeve; Marian B E Menke-Pluymers; Peter Bult; Vivianne C G Tjan-Heijnen Journal: N Engl J Med Date: 2009-08-13 Impact factor: 91.245