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Extracapsular extension in the positive sentinel lymph node: a marker of poor prognosis in cT1-2N0 breast cancer patients?

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Abstract

Objective

This study aims to evaluate whether extracapsular extension (ECE) in the sentinel lymph node (SLN) is associated with involvement of ≥ 4 lymph node metastases at completion axillary lymph node dissection (ALND) and the effect on 5-year disease-free survival (DFS) and 10-year overall survival (OS).

Summary background data

ECE in a SLN is usually a contraindication for omitting completion ALND in cT1-2N0 breast cancer patients treated with breast-conserving therapy and 1–2 positive SLN(s).

Methods

All cT1-2N0 breast cancer patients with 1–3 positive SLN(s) who underwent ALND between 2005 and 2008 were selected from the Netherlands Cancer Registry. Logistic regression analysis was used to determine the association between ECE and ≥ 4 lymph node metastases. Five-year DFS and 10-year OS were analyzed using Kaplan–Meier survival analysis. Cox regression analysis was performed to correct for other prognostic factors.

Results

A total of 3502 patients were included. Information on ECE was available for 2111 (60.3%) patients, consisting of 741 (35.1%) patients with and 1370 (64.9%) without ECE. The incidence of ≥ 4 lymph node metastases was 116 (15.7%) in the ECE group vs. 80 (5.8%) in the group without ECE (p < 0.001). Five-year DFS rate was 86.4% in the ECE group compared to 88.8% in the group without ECE (p = 0.085). 10-year OS rate was 78.6% compared to 83.0% (p = 0.018), respectively. Cox regression analysis showed that ECE was not an independent prognostic factor for both DFS and OS.

Conclusions

ECE was significantly associated with involvement of ≥ 4 lymph node metastases in the completion ALND group. ECE was not an independent prognostic factor for both DFS and OS.

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Abbreviations

ALND:

Axillary lymph node dissection

BCT:

Breast-conserving therapy

DFS:

Disease-free survival

DM:

Distant metastasis

ECE:

Extracapsular extension

HR:

Hazard ratio

IKNL:

Comprehensive Cancer Organisation the Netherlands

LR:

Local recurrence

NCR:

Netherlands Cancer Registry

OS:

Overall survival

PALGA:

Pathological Anatomical National Automated Archive

RR:

Regional recurrence

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

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Acknowledgements

The authors thank the Netherlands Cancer Registry and Pathological Anatomical National Automated Archive for providing the clinical and histopathological data.

Funding

The research reported in this article was supported by CZ funds. This study was not funded. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Marissa L. G. Vane, Maria A. Willemsen & Marjolein L. Smidt

  2. GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Marissa L. G. Vane, Loes F. S. Kooreman & Marjolein L. Smidt

  3. Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands

    Lori M. van Roozendaal

  4. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands

    Sander M. J. van Kuijk

  5. Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Loes F. S. Kooreman

  6. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Sabine Siesling

  7. Department of Health Technology and Services Research, MIRA Institute for Biomedical Science and Technical Medicine, University of Twente, Enschede, The Netherlands

    Sabine Siesling

  8. Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands

    Hans H. W. de Wilt

Authors
  1. Marissa L. G. Vane
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  2. Maria A. Willemsen
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  3. Lori M. van Roozendaal
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  4. Sander M. J. van Kuijk
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  5. Loes F. S. Kooreman
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  6. Sabine Siesling
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  7. Hans H. W. de Wilt
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  8. Marjolein L. Smidt
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Corresponding author

Correspondence to Marissa L. G. Vane.

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Conflict of interest

None of the authors reported have a conflict of interest related to the outcomes of this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Vane, M.L.G., Willemsen, M.A., van Roozendaal, L.M. et al. Extracapsular extension in the positive sentinel lymph node: a marker of poor prognosis in cT1-2N0 breast cancer patients?. Breast Cancer Res Treat 174, 711–718 (2019). https://doi.org/10.1007/s10549-018-05074-y

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  • DOI: https://doi.org/10.1007/s10549-018-05074-y

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