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Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Contralateral axillary nodal metastases (CAM) is classified as stage IV disease, although many centers treat CAM with curative intent. We hypothesized that patients with CAM, treated with multimodality therapy, would have improved overall survival (OS) versus patients with distant metastatic disease (M1) and similar OS to those with locally advanced breast cancer (LABC).

Methods

Using the NCDB (2004–2016), we categorized adult patients with node-positive breast cancer into three study groups: LABC, CAM, and M1. Kaplan-Meier curves were used to visualize the unadjusted OS. Cox proportional hazards models were used to estimate the association of study group with OS.

Results

A total of 94,487 patients were identified: 122 with CAM, 12,325 with LABC, and 82,040 with M1 (median follow-up 63.6 months). LABC and CAM patients had similar histology and rates of chemotherapy and endocrine therapy receipt. However, the CAM group had significantly larger tumors, more estrogen-receptor expression, higher T-stage, and more mastectomies than the LABC group. Compared with M1 patients, CAM patients were more likely to have grade 3 and cT4 tumors. Patients with CAM and LABC had similar 5-year unadjusted OS and significantly improved OS vs M1 patients. After adjustment, LABC and CAM patients continued to have similar OS and better OS vs M1 patients.

Conclusions

CAM patients who receive multi-modal therapy with curative intent may have OS more comparable to LABC patients than M1 patients. Out data support a reevaluation of whether CAM should remain classified as M1, as N3 may better reflect disease prognosis and treatment goals.

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Acknowledgment

Dr. O. Fayanju is supported by the National Institutes of Health (NIH) under Award Number 1K08CA241390 (PI: Fayanju). Samantha Thomas had a consulting relationship with Abbvie, Inc. on work related to bioequivalence that ended in January 2019. This work was unrelated to this work.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Amanda L. Nash MD, Jennifer K. Plichta MD, MS, Oluwadamilola M. Fayanju MD, MA, MPHS, E. Shelley Hwang MD, MPH, Rachel A. Greenup MD, MPH & Laura H. Rosenberger MD, MS

  2. Duke Cancer Institute, Duke University, Durham, NC, USA

    Samantha M. Thomas MS, Jennifer K. Plichta MD, MS, Oluwadamilola M. Fayanju MD, MA, MPHS, E. Shelley Hwang MD, MPH, Rachel A. Greenup MD, MPH & Laura H. Rosenberger MD, MS

  3. Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Samantha M. Thomas MS

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  1. Amanda L. Nash MD
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  4. Oluwadamilola M. Fayanju MD, MA, MPHS
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Correspondence to Laura H. Rosenberger MD, MS.

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This work is also supported by the Duke Cancer Institute through NIH Grant P30CA014236 (PI: Kastan).

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Nash, A.L., Thomas, S.M., Plichta, J.K. et al. Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer?. Ann Surg Oncol 28, 5544–5552 (2021). https://doi.org/10.1245/s10434-021-10461-9

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  • DOI: https://doi.org/10.1245/s10434-021-10461-9

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