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Axillary nodal involvement by primary tumor features in early breast cancer: an analysis of 2600 patients

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Abstract

Background

Primary tumor characteristics, which are readily available to all clinicians, may aid in selecting the optimal adjuvant therapy for patients with breast cancer (BC). Herein, we investigated the relationship between tumor size, hormone receptor and HER2 status, Ki67 and age with axillary lymph node metastases (ALNM) in early-BC patients.

Methods

We analyzed data on consecutive 2600 early-BC cases collected in the registry of Fondazione IRCC Istituto Nazionale dei Tumori, Milano, Italy. Correlation between Ki67 and primary tumor size (T-size) was calculated by Spearman’s rank correlation coefficient. Association of ALNM with Ki67 and other tumor characteristics was investigated by logistic regression. Adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated in all cases, and separately analyzed according to age, T-size and BC subtype.

Results

Large tumor size strongly associated to ALNM, with an adjusted odds ratio (OR) for each 5-mm increase of 1.32 (95% CI 1.24–1.41), except for triple-negative BC (TNBC) cases. In tumors =10 mm, without lymphovascular invasion, representing the strongest predictor of ALNM (OR 6.09, 95% CI 4.93–7.53), Ki67 resulted particularly informative, with a fourfold increased odds of ALNM for values > 30%.

Conclusions

These results raise the question whether axillary node status is redundant in cases with exceptionally good features, i.e., small tumors with low Ki67, or in those candidate to adjuvant systemic treatment/radiotherapy anyway including TNBC, and support the incorporation of primary BC tumor characteristics as stratification factors in ongoing trials aiming at de-escalating axillary surgical procedures.

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Acknowledgements

The Breast Cancer Registry of Fondazione IRCCS Istituto Nazionale Tumori, Milano is subsidized by institutional funds (INT 5 × 1000 funds).

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Author notes

  1. M. C. De Santis and E. La Rocca have equal contribution and are the co-first authors.

  2. M. Sant and S. Di Cosimo have equal contribution and are the co-last authors.

Authors and Affiliations

  1. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    M. C. De Santis, E. La Rocca & G. Di Lorenzo

  2. School of Medicine, Università degli Studi di Milan, Milan, Italy

    E. La Rocca, G. Di Lorenzo, G. Galli, G. Pruneri & F. De Braud

  3. Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    E. Meneghini & M. Sant

  4. Medical Oncology, Ospedale Policlinico S. Martino IRCCS, Genova, Italy

    G. Bregni

  5. Division of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    G. Galli & M. Di Nicola

  6. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    S. Folli & M. Gennaro

  7. Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    G. Pruneri & B. Paolini

  8. Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G Amadeo 42, 20133, Milan, Italy

    M. G. Daidone & S. Di Cosimo

  9. Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    F. De Braud & G. Apolone

Authors
  1. M. C. De Santis
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  2. E. La Rocca
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  5. G. Di Lorenzo
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  6. G. Galli
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  7. M. Di Nicola
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  8. S. Folli
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  10. G. Pruneri
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  12. M. G. Daidone
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  15. M. Sant
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Corresponding author

Correspondence to S. Di Cosimo.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The present study has been reviewed and approved by the Internal  Review Board of National Cancer Institute, Milan, Italy. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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De Santis, M.C., La Rocca, E., Meneghini, E. et al. Axillary nodal involvement by primary tumor features in early breast cancer: an analysis of 2600 patients. Clin Transl Oncol 22, 786–792 (2020). https://doi.org/10.1007/s12094-019-02188-7

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  • DOI: https://doi.org/10.1007/s12094-019-02188-7

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