1
|
Weiser R, Polychronopoulou E, Haque W, Hatch SS, He J, Qiu S, Markowitz A, Gradishar WJ, Kuo YF, Klimberg VS. Prognosis and Chemotherapy Use in Breast Cancer Patients with Multiple Lymphatic Micrometastases: An NCDB Analysis. Ann Surg Oncol 2021; 28:8717-8727. [PMID: 34250555 DOI: 10.1245/s10434-021-10374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of involved lymph nodes negatively affects prognosis in breast cancer patients. Nevertheless, current staging and treatment recommendations do not distinguish between patients with single versus multiple lymphatic micrometastases. In this study, we aim to better characterize these patients. METHODS The National Cancer Database was retrospectively queried to identify 486,800 women with stage I-III, estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative (ER+/PR+/HER2-) breast cancer and nodal status of N0, N1mi with 1 (Nmic1) or more (Nmic > 1) involved nodes, and N1 with 1 involved node (N1.1), from 2010 to 2016. Patients with different nodal statuses were compared regarding treatment characteristics, survival, and benefit from chemotherapy by their 21-gene recurrence score (RS). RESULTS Of the 23,072 N1mi patients, 88.3% were Nmic1 and 11.7% were Nmic > 1. Nmic > 1 patients were younger, had larger and higher-grade tumors, with more lymphovascular invasion, and were more commonly treated by axillary dissection, radiation, and chemotherapy than Nmic1 patients. In that, they were comparable with N1.1 patients. Five-year survival of Nmic > 1 patients (88.1%) was worse than Nmic1 patients (90.1%; p = 0.02), but similar to N1.1 patients (87.9%). Nmic1, Nmic > 1, and N1.1 patients with RS 11-25 exhibited a < 2% absolute survival benefit associated with chemotherapy. With RS > 25, Nmic > 1 patients showed a 3.5% benefit, similar to Nmic1 (4.8%) and lower than N1.1 (10.9%) patients. CONCLUSIONS Nmic > 1 breast cancer patients have worse prognoses than Nmic1 patients, similar to N1.1 patients. Our data suggest those patients with RS 11-25 have minimal benefit from chemotherapy. These findings should be taken into account when discussing prognosis and considering chemotherapy in patients with lymphatic micrometastases.
Collapse
Affiliation(s)
- Roi Weiser
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| | - Efstathia Polychronopoulou
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jing He
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Suimin Qiu
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Avi Markowitz
- Division of Hematology/Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Gradishar
- Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. .,MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Demicheli R, Fornili M, Querzoli P, Pedriali M, Alberti S, Desmedt C, Biganzoli E. Microscopic tumor foci in axillary lymph nodes may reveal the recurrence dynamics of breast cancer. Cancer Commun (Lond) 2019; 39:35. [PMID: 31217037 PMCID: PMC6582468 DOI: 10.1186/s40880-019-0381-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Romano Demicheli
- Unit of Medical Statistics, Biometry and Bioinformatics, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy
| | - Marco Fornili
- Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy
| | - Patrizia Querzoli
- Section of Surgical Pathology, Department of Morphology, Surgical and Experimental Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Massimo Pedriali
- Operative Unit of Surgical Pathology, Azienda Ospedaliera - Universitaria, University of Ferrara, 44121, Ferrara, Italy
| | - Saverio Alberti
- Section of Medical Genetics, Department of Biomedical and Odontoiatric Sciences, Morphological and Functional Imaging, University of Messina, 98125, Messina, Italy
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, Katholieke Universiteit Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Bioinformatics, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy.
| |
Collapse
|
3
|
Relationship of Lymph Node Micrometastasis and Micropapillary Component and Their Joint Influence on Prognosis of Patients With Stage I Lung Adenocarcinoma. Am J Surg Pathol 2017; 41:1212-1220. [PMID: 28692600 DOI: 10.1097/pas.0000000000000901] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the relationship between lymph node micrometastasis and histologic patterns of adenocarcinoma, with a particular focus on their joint effect on prognosis. We retrospectively reviewed 235 patients with stage I adenocarcinoma from January 2009 to December 2009. Lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratin (AE1/AE3) and thyroid transcription factor-1. A logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis on prognosis. Lymph node micrometastasis was observed in 35 patients (15%). Patients with micrometastasis had significantly worse recurrence-free survival (P<0.001) and overall survival (P<0.001) compared with those without micrometastasis. Micropapillary component was confirmed as an independent predictor of increased frequency of micrometastasis (P<0.001). Among 62 patients with adenocarcinoma with a micropapillary component, 23 (37%) had lymph node micrometastasis. Micropapillary-positive/micrometastasis-positive patients had significantly worse survival compared with micropapillary-positive/micrometastasis-negative patients (RFS, P=0.039; OS, P=0.002) and micropapillary-negative patients (recurrence-free survival, P<0.001; overall survival, P<0.001). Moreover, the presence of micrometastasis correlated with a higher risk of locoregional recurrence (P=0.031) rather than distant recurrence (P=0.456) in micropapillary-positive patients. In summary, lymph node micrometastasis was more frequently observed in adenocarcinoma with a micropapillary component. Moreover, lymph node micrometastasis could provide helpful prognostic information in patients with resected stage I lung adenocarcinoma with a micropapillary component; thus, immunohistochemical detection of micrometastatic tumor cells in lymph nodes should be recommended.
Collapse
|
4
|
Mittendorf EA, Bedrosian I, Hunt KK. Reply to L. Antolini et al. J Clin Oncol 2015; 33:3978-9. [PMID: 26282647 DOI: 10.1200/jco.2015.63.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Kelly K Hunt
- The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|