Skip to main content

Advertisement

SpringerLink
Log in

Effect of lymph node metastasis size on breast cancer-specific and overall survival in women with node-positive breast cancer

  • Brief Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

We investigated whether increasing size of lymph nodes (LN) metastases is associated with lower breast cancer-specific survival (BCSS) and overall survival (OS) independent of the number of positive LNs. Using Surveillance, Epidemiology, and End Results registry data, we identified 8791 women diagnosed between 1990 and 2003 with node-positive, non-metastatic invasive breast cancer treated with surgery and axillary LN dissection. Size of the largest involved LN metastasis was categorized as ≤2 mm, >2 mm to <2 cm, and ≥2 cm. BCSS and OS were estimated using the Kaplan–Meier method and compared using log-rank statistics. Adjusted hazard ratios (HR) were calculated using Cox proportional hazards models. Median follow-up was 109 months. Largest LN size was ≤2 mm, >2 mm to <2 cm, and ≥2 cm in 2219 (25.2 %), 5047 (57.4 %), and 1525 (17.3 %) women, respectively. The 10-year BCSS for women with LNs ≤2 mm, >2 mm to <2 cm, and ≥2 cm was 82.9, 75.5, 64.8 %, respectively (p < 0.001). On multivariable analysis, large (≥2 cm) LN size was significantly associated with worsened BCSS (HR: 1.169; p = 0.026) and OS (HR: 1.169; p = 0.006) in addition to age, race, grade, PR status, adjuvant radiation, T-stage, and number of positive LNs. Large (≥2 cm) LNs metastases were associated with lower BCSS and OS after controlling for other known prognostic factors including number of positive LNs. LN size could be useful to risk-stratify patients for adjuvant therapy if these results are validated in future prospective studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Fisher B, Ravdin RG, Ausman RK et al (1968) Surgical adjuvant chemotherapy in cancer of the breast: results of a decade of cooperative investigation. Ann Surg 168:337–356

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716

    Article  Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135

    Article  Google Scholar 

  4. Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK (1999) Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol 17:2334–2340

    Article  CAS  PubMed  Google Scholar 

  5. Fisher B, Bauer M, Wickerham DL et al (1983) Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer 52:1551–1557

    Article  CAS  PubMed  Google Scholar 

  6. Attiyeh FF, Jensen M, Huvos AG, Fracchia A (1977) Axillary micrometastasis and macrometastasis in carcinoma of the breast. Surg Gynecol Obstet 144:839–842

    CAS  PubMed  Google Scholar 

  7. Fisher ER, Palekar A, Rockette H, Redmond C, Fisher B (1978) Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4). V. Significance of axillary nodal micro- and macrometastases. Cancer 42:2032–2038

    Article  CAS  PubMed  Google Scholar 

  8. Rosen PP, Saigo PE, Braun DW et al (1981) Axillary micro- and macrometastases in breast cancer: prognostic significance of tumor size. Ann Surg 194:585–591

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Barranger E, Coutant C, Flahault A et al (2005) An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat 91:113–119

    Article  PubMed  Google Scholar 

  10. Kohrt HE, Olshen RA, Bermas HR et al (2008) New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer 8:66

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mittendorf EA, Hunt KK, Boughey JC et al (2012) Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg 255:109–115

    Article  PubMed  PubMed Central  Google Scholar 

  12. Harris EE, Freilich J, Lin HY, Chuong M, Acs G (2013) The impact of the size of nodal metastases on recurrence risk in breast cancer patients with 1–3 positive axillary nodes after mastectomy. Int J Radiat Oncol Biol Phys 85:609–614

    Article  PubMed  Google Scholar 

  13. Surveillance, Epidemiology, and End Results (SEER) Program Public-Use Data (1973–2008) National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, 2011. http://www.seer.cancer.gov. Accessed 1 Aug 2014

  14. Edge SB, Byrd DR, Compton CC et al (eds) (2010) Breast in AJCC cancer staging manual, 7th edn. New York, Springer, pp 347–376

    Google Scholar 

  15. Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305:569–575

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kim J, Yoo SW, Kang SR et al (2012) Prognostic significance of metabolic tumor volume measured by (18)F-FDG PET/CT in operable primary breast cancer. Nucl Med Mol Imaging 46:278–285

    Article  PubMed  PubMed Central  Google Scholar 

  17. Song BI, Lee SW, Jeong SY et al (2012) 18F-FDG uptake by metastatic axillary lymph nodes on pretreatment PET/CT as a prognostic factor for recurrence in patients with invasive ductal breast cancer. J Nucl Med 53:1337–1344

    Article  CAS  PubMed  Google Scholar 

  18. Crabb SJ, Cheang MC, Leung S et al (2008) Basal breast cancer molecular subtype predicts for lower incidence of axillary lymph node metastases in primary breast cancer. Clin Breast Cancer 8:249–256

    Article  PubMed  Google Scholar 

  19. Van Calster B, Vanden Bempt I, Drijkoningen M et al (2009) Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status: triple positive tumours are more likely lymph node positive. Breast Cancer Res Treat 113:181–187

    Article  PubMed  Google Scholar 

  20. Fisher BJ, Perera FE, Cooke AL et al (1997) Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: an indication for radiotherapy? Int J Radiat Oncol Biol Phys 38:551–559

    Article  CAS  PubMed  Google Scholar 

  21. Neri A, Marrelli D, Roviello F et al (2005) Prognostic value of extracapsular extension of axillary lymph node metastases in T1 to T3 breast cancer. Ann Surg Oncol 2005(12):246–253

    Article  Google Scholar 

  22. Hetelekidis S, Schnitt SJ, Silver B et al (2000) The significance of extracapsular extension of axillary lymph node metastases in early-stage breast cancer. Int J Radiat Oncol Biol Phys 46:31–34

    Article  CAS  PubMed  Google Scholar 

  23. Gruber G, Cole BF, Castiglione-Gertsch M et al (2008) Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer. Ann Oncol 19:1393–1401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, United States

    Brent S. Rose

  2. Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States

    Wei Jiang

  3. Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer, Institute and Center for Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02115, United States

    Rinaa S. Punglia

Authors
  1. Brent S. Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rinaa S. Punglia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rinaa S. Punglia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rose, B.S., Jiang, W. & Punglia, R.S. Effect of lymph node metastasis size on breast cancer-specific and overall survival in women with node-positive breast cancer. Breast Cancer Res Treat 152, 209–216 (2015). https://doi.org/10.1007/s10549-015-3451-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3451-y

Keywords

Search

Navigation