Predictors of Axillary Lymph Node Metastases (ALNM) in a Korean Population with T1-2 Breast Carcinoma: Triple Negative Breast Cancer has a High Incidence of ALNM Irrespective of the Tumor Size

다국어 초록 (Multilingual Abstract)

Purpose :We estimated the likelihood of breast cancer patients having axillary lymph node metastases (ALNM) based on a variety of clinical and pathologic factors.
Materials and Methods :Three hundred sixty-one breast cancer patients without distant metastases and who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy (MRM) were identified, and we retrospectively reviewed their pathology records and treatment charts.
Results :Positive axillary lymph nodes were detected in 104 patients for an overall incidence of 28.8%: 2 patients (5%) with T1a tumor, 5 (9.2%) with T1b tumor, 24 (21.8%) with T1c tumor and 73 (44.2%) with T2 tumor. On the multivariate analysis, an increased tumor size (adjusted OR=11.87, p=0.02), the presence of lymphovascular invasion (adjusted OR=7.41, p＜0.01), a triple negative profile (ER/PR-, Her2-) (adjusted OR=2.09, p=0.04) and a palpable mass at the time of diagnosis (adjusted OR=2.31, p=0.03) were all significant independent factors for positive ALNM.
Conclusion :In our study, the tumor size, the presence of lymphovascular invasion, a triple negative profile and a palpable mass were the independent predictive factors for ALNM. The tumor size was the strongest predictor of ALNM. Thus, the exact estimation of the extent of tumor is necessary for clinicians to optimize the patients’ care. Patients with a triple negative profile have a high incidence of ALNM irrespective of the tumor size.

참고문헌 (Reference)

1 손병호, "임상적으로 림프절 전이를 보이지 않는 유방암 환자에서 방사성 동위원소를 이용한 감시림프절 생검의 성적" 한국유방암학회 10 (10): 141-146, 2007

2 Tinnemans JG, "Treatment and survival of female patients with nonpalpable breast carcinoma" 209 : 249-253, 1989

3 Kang HS, "The predictors of axillary node metastasis in 2 cm or less breast cancer univariate and multivaritate analysis" 2 : 7-13, 1999

4 Bader AA, "T1 breast cancer: identification of patients at low risk of axillary lymph node metastases" 76 : 11-17, 2002

5 Fisher B, "Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: an NASABP update" 52 : 1551-1557, 1983

6 Mansel RE, "Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial" 98 : 599-609, 2006

7 Carey LA, "Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study" 295 : 2492-2502, 2006

8 Colleoni M, "Prognostic role of the extent of peritumoral vascular invasion in operable breast cancer" 18 : 1632-1640, 2007

9 Jonjic N, "Predicting sentinel lymph node metastases in infiltrating breast carcinoma with vascular invasion" 14 : 306-311, 2006

10 Silverstein MJ, "Predicting axillary nodal positivity in 2282 patients with breast carcinoma" 25 : 767-772, 2001

11 Harden SP, "Predicting axillary lymph node metastases in patients with T1 infiltrating ductal carcinoma of the breast" 10 : 155-159, 2001

12 Consensus statement treatment of early-stage breast cancer, "National Institutes of Health Consensus Development Panel" 11 : 1-5, 1992

13 "NIH Consensus Conference, Treatment of early-stage breast cancer" 265 : 391-395, 1991

14 Nemoto T, "Management and survival of female breast cancer: results of a national survey by the American college of surgeons" 45 : 2917-2924, 1980

15 Fein DA, "Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes" 65 : 34-39, 1997

16 Chua B, "Frequency and predictors of axillary lymph node metastases in invasive breast cancer" 71 : 723-728, 2001

17 Rosen PP, "Factors influencing prognosis in nodenegative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up" 11 : 2090-2100, 1993

18 Cetinas SK, "Factors influencing axillary node metastasis in breast cancer" 92 : 416-422, 2006

19 Ernst MF, "Early and late morbidity associated with axillary levels I–III dissection in breast cancer" 79 : 151-155, 2002

20 Onitilo AA, "Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival" 7 : 4-13, 2009

21 Kambouris AA, "Axillary node metastases in relation to size and location of breast cancers: analysis of 147 patients" 62 : 519-524, 1996

22 Davies GC, "Assessment of axillary lymph node status" 192 : 148-151, 1980

23 Frederick LG, "AJCC Cancer Staging Manual/American Joint Committee on Cancer. Breast. 6th ed" Lippincott Williams & Wilkins 223-240, 2002

24 Martelli G, "A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up" 242 : 1-6, 2005

25 Bevilacqua J, "A prospective validated model for predicting axillary node metastases based on 2000 sentinel node procedures: the role of tumor location [corrected]" 28 : 490-500, 2002