Breast Cancer Research and Treatment

, Volume 131, Issue 2, pp 645–651 | Cite as

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

  • Johanna H. Vestjens
  • Maaike de Boer
  • Paul J. van Diest
  • Carolien H. van Deurzen
  • Jos A. van Dijck
  • George F. Borm
  • Eddy M. Adang
  • Peter Bult
  • Vivianne C. Tjan-HeijnenEmail author


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.


Nodal isolated tumor cells Breast cancer 



We thank Wim A.J.G. Lemmens for his assistance with statistical analyses. This project has received funding from the Netherlands Organization for Health Research and Development (ZonMw 945-06-509) and supported by the Breast Research Group of The Netherlands (BOOG)

Conflict of interest



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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Johanna H. Vestjens
    • 1
  • Maaike de Boer
    • 1
  • Paul J. van Diest
    • 3
  • Carolien H. van Deurzen
    • 3
  • Jos A. van Dijck
    • 2
  • George F. Borm
    • 2
  • Eddy M. Adang
    • 2
  • Peter Bult
    • 2
  • Vivianne C. Tjan-Heijnen
    • 1
    Email author
  1. 1.Department of Internal Medicine, Division of Medical Oncology, GROW—School for Oncology and Developmental BiologyMaastricht University Medical CentreMaastrichtThe Netherlands
  2. 2.Radboud University Nijmegen Medical CentreNijmegenThe Netherlands
  3. 3.University Medical Centre UtrechtUtrechtThe Netherlands

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