Jul 24, 2008 - Examination of sentinel lymph nodes consisted of hematoxylin and .... pN1micro: metastasis in axillary lymph nodes with a size between 0.2 ...
Annals of Oncology Advance Access published July 24, 2008
original article
Annals of Oncology doi:10.1093/annonc/mdn535
Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study P. D. Gobardhan4, S. G. Elias1, E. V. E. Madsen4, V. Bongers2, H. J. M. Ruitenberg3, C. I. Perre4 & T. van Dalen4* 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; 2Department of Nuclear Medicine, Diakonessenhuis Utrecht; 3Department of Pathology, Diakonessenhuis Utrecht, The Netherlands; 4Department of Surgery, Diakonessenhuis Utrecht.
Received 11 March 2008; revised 25 June 2008; accepted 1 July 2008
Background: The prognostic meaning and thus indication for adjuvant therapy of lymphogenic micrometastases in breast cancer patients is still under debate. sentinel lymph node biopsy. Examination of sentinel lymph nodes consisted of hematoxylin and eosin and immunohistochemistry staining following serial sectioning of the sentinel node. Patients were divided into four groups: pN0 (n = 423), pN1micro (n = 81), pN1a (n = 130) and pN‡1b (n = 69). Median follow-up was 40 months. Results: At the end of follow-up, 53 patients had died and 64 had recurrent disease. Compared with pN0 and following adjustment for possible confounders, including adjuvant systemic treatment, overall survival was not significantly different for pN1micro while significantly worse for pN1a and pN‡1b {hazard ratio (HR) [95% confidence interval (CI)]: 0.59 [0.14–2.58], 4.31 [1.85–10.01], 10.66 [4.04–28.14], respectively}. Likewise, disease-free survival was not significantly different for pN1micro and worse for pN1a and pN‡1b (HR [95% CI]: 1.43 [0.67–3.02], 2.79 [1.37– 5.66], 7.13 [3.27–15.54], respectively). Distant metastases were more commonly observed in the pN1micro than in the pN0 group, but still not as common as in the pN1a or pN‡1b group (HR [95% CI]: 4.85 [1.79–13.18], 10.34 [3.82–28.00], 23.25 [7.88–68.56], respectively). Conclusion: Although the risk of distant metastases was higher in patients in the pN1micro than in the pN0 group, no statistically significant differences were observed in overall or disease-free survival between pN0 and pN1micro. Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients. Key words: breast cancer, micrometastases, prognosis, sentinel lymph node
introduction Axillary staging is a hallmark of breast cancer surgery as metastatic lymph node involvement is a strong prognosticator. The presence of lymphogenic metastases and number of involved lymph nodes contribute importantly to adjuvant systemic treatment decisions. In the era of the sentinel lymph node biopsy (SLNB), lymph nodes are assessed more thoroughly for tumor involvement than before. Consequently, the proportion of patients diagnosed with micrometastatic lymph node involvement (i.e. tumor deposits >0.2 and
