Breast Cancer Research and Treatment

, Volume 131, Issue 2, pp 645–651

Prognostic impact of isolated tumor cells in breast cancer axillary nodes: single tumor cell(s) versus tumor cell cluster(s) and microanatomic location

Authors

  • Johanna H. Vestjens
    • Department of Internal Medicine, Division of Medical Oncology, GROW—School for Oncology and Developmental BiologyMaastricht University Medical Centre
  • Maaike de Boer
    • Department of Internal Medicine, Division of Medical Oncology, GROW—School for Oncology and Developmental BiologyMaastricht University Medical Centre
  • Paul J. van Diest
    • University Medical Centre Utrecht
  • Carolien H. van Deurzen
    • University Medical Centre Utrecht
  • Jos A. van Dijck
    • Radboud University Nijmegen Medical Centre
  • George F. Borm
    • Radboud University Nijmegen Medical Centre
  • Eddy M. Adang
    • Radboud University Nijmegen Medical Centre
  • Peter Bult
    • Radboud University Nijmegen Medical Centre
    • Department of Internal Medicine, Division of Medical Oncology, GROW—School for Oncology and Developmental BiologyMaastricht University Medical Centre
Epidemiology

DOI: 10.1007/s10549-011-1771-0

Cite this article as:
Vestjens, J.H., de Boer, M., van Diest, P.J. et al. Breast Cancer Res Treat (2012) 131: 645. doi:10.1007/s10549-011-1771-0

Abstract

In breast cancer, it has been shown that pN0(i+) and pN1mi have a comparable negative impact on disease-free survival, compared with pN0. However, pN0(i+) is considered to be a heterogeneous group. We determined the effect of metastatic size and microanatomic location within the pN0(i+) group on breast cancer recurrence. We included all Dutch breast cancer patients diagnosed in 1998–2005 with favorable primary tumor characteristics and a final nodal status of pN0(i+). For this analysis, only patients without adjuvant systemic therapy were eligible (n = 513). Presence of single tumor cells versus cell clusters, metastatic size and microanatomic location were recorded. Primary endpoint was disease-free survival. Analyses were adjusted for age at diagnosis, tumor size, tumor grade, axillary treatment and hormone receptor status. The 5-year disease-free survival of patients with single tumor cell(s) (n = 93) was 78.6% and with tumor cell cluster(s) (n = 404) 77.1%. The hazard ratio for disease events was 1.05 (95% CI 0.63–1.76) for cell cluster(s) compared with single cell(s). In a Cox regression model, doubling of metastatic tumor size corresponded to a hazard ratio of 1.21 (95% CI 1.02–1.43). The adjusted hazard ratio was 0.90 (95% CI 0.54–1.50) for parenchymal (n = 112) versus sinusoidal location (n = 395). Single tumor cells bear similar prognostic information as small tumor cell clusters, even though results do suggest that within the pN0(i+) group, increasing size of nodal involvement is associated with reduced survival. Microanatomic location does not seem to have prognostic relevance.

Keywords

Nodal isolated tumor cells Breast cancer

Copyright information

© Springer Science+Business Media, LLC. 2011