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The impact of nodal micrometastasis on mortality among women with early-stage breast cancer

  • Epidemiology
  • Published:
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Abstract

Purpose

The clinical significance of nodal micrometastasis is debated. Our primary objective was to determine whether, among women with early-stage breast cancer, regional lymph node micrometastasis is an independent risk factor for mortality. The secondary objective was to identify subgroups of women who have the highest risk of death from early-stage breast cancer with micrometastases.

Methods

206,625 women diagnosed with early-stage breast cancer (IA, IB, and IIA) from 2004 to 2012 were identified in the Surveillance, epidemiology, and end results database. Nodal status was classified as node-negative, isolated-tumor cells, micrometastases, and macrometastases. Women were classified into eight ethnic groups. Logistic regression was performed to estimate the odds ratio of being diagnosed with micrometastases. The Cox proportional hazard model was used to estimate the hazard ratio (HR) of breast cancer-specific death associated with micrometastases for each ethnic group.

Results

The 8-year breast cancer-specific survival was 96.6 % for women with node-negative breast cancers and was 94.6 % for women with micrometastases (adjusted HR 1.49; 95 % CI 1.31–1.69; P < .001). Among women with micrometastases, the 8-year breast cancer-specific survival was 95.1 % for white women and was 90.6 % for black women (HR 1.80; 95 % CI 1.29–2.52; P = .0006).

Conclusion(s)

Nodal micrometastasis is an independent risk factor for breast cancer mortality among women with early-stage breast cancer. Black women are more likely to die from breast cancer with micrometastases than white women.

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Acknowledgements

We acknowledge the National Comprehensive Cancer Network (NCCN) for the citation of the Clinical Practice Guidelines in Oncology, Breast Cancer Version 1.2016 (www.nccn.org).

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Authors and Affiliations

  1. Women’s College Research Institute/Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada

    Javaid Iqbal, Ophira Ginsburg, Vasily Giannakeas, Paula A. Rochon, John L. Semple & Steven A. Narod

  2. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Ophira Ginsburg & Paula A. Rochon

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Ophira Ginsburg & Paula A. Rochon

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Ophira Ginsburg, Vasily Giannakeas & Steven A. Narod

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  1. Javaid Iqbal
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  2. Ophira Ginsburg
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Correspondence to Steven A. Narod.

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The authors report no conflict of interest.

Ethical approval

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. The research ethics board of the Women’s College Research Institute/Women’s College Hospital, Toronto, Ontario approved this study.

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

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Iqbal, J., Ginsburg, O., Giannakeas, V. et al. The impact of nodal micrometastasis on mortality among women with early-stage breast cancer. Breast Cancer Res Treat 161, 103–115 (2017). https://doi.org/10.1007/s10549-016-4015-5

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  • DOI: https://doi.org/10.1007/s10549-016-4015-5

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