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Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes

  • Clinical trial
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Abstract

Purpose

The clinical significance of lymph node micrometastases and isolated tumor cells (ITCs) in breast cancer is still controversial. After a median follow-up of 52 months, a report from the Swedish Multicenter Cohort Study presented a worse cancer-specific and event-free survival for patients with micrometastases than node-negative individuals, but could not demonstrate a significant difference in overall survival (OS). Due to the tendency of breast cancer to relapse after more than 5–10 years, we now report the long-term survival of the cohort.

Methods

Between September 2000 and January 2004, 3355 breast cancer patients were included in a prospective cohort. Sentinel lymph node biopsy was always performed. Patients were classified in four groups according to their overall nodal stage: node negative (N0, 2372), ITCs (113), micrometastases (123), and macrometastases (747). Kaplan–Meier survival estimates and Cox proportional hazard regression models were applied.

Results

Median follow-up was 156 months. Ten-year cancer-specific survival and OS were significantly lower in case of micrometastases than in N0 (84.7 vs. 93.5%, p = 0.001, and 75.5 vs. 84.2%, p = 0.046, respectively). In case of macrometastases, corresponding survival rates were 82.8 and 74.3%. Only for those aged less than 50 years, cancer-specific survival and OS were significantly worse in case of ITCs than N0. Patients with micrometastases received less often chemotherapy than those with macrometastases (24.4 vs. 53.9%).

Conclusions

Lymph node micrometastases in breast cancer have a prognostic significance. This study demonstrates a similar survival for patients with micrometastases and those with macrometastases, possibly due to systemic undertreatment.

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Acknowledgements

The authors thank the medical staff at all participating hospitals for the inclusion and follow-up of patients. A special thanks to Marie-Louise Walker-Engström at the Centre for Clinical Research Västerås, Uppsala University for data management.

Funding

The study was funded by Grants from the Swedish Society for Medical Research, Swedish Breast Cancer Association (BRO) and the Swedish Cancer Society.

Author information

Authors and Affiliations

  1. Department of Surgery, Västmanland County Hospital, 72189, Västerås, Sweden

    Yvette Andersson & L. Bergkvist

  2. Center for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden

    Yvette Andersson & L. Bergkvist

  3. Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden

    J. Frisell

  4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    J. Frisell & J. de Boniface

  5. Department of Surgery, Capio St Göran’s Hospital, Stockholm, Sweden

    J. de Boniface

Authors
  1. Yvette Andersson
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  2. L. Bergkvist
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  4. J. de Boniface
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Corresponding author

Correspondence to Yvette Andersson.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was approved by the respective Regional Ethics Committees and the Central Ethics Committee in Stockholm (No. 00-053, updated ethical review in 2015, No. 2015/979-32).

Informed consent

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

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Andersson, Y., Bergkvist, L., Frisell, J. et al. Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Breast Cancer Res Treat 171, 359–369 (2018). https://doi.org/10.1007/s10549-018-4820-0

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  • DOI: https://doi.org/10.1007/s10549-018-4820-0

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