title: Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer.
abstract: OBJECTIVE
  Clinical records of patients undergoing surgery for breast cancer were reviewed in order to evaluate the prognostic role of lymph-node level involvement.
  
  
  METHODS
  From 1982 to 1991, 1143 patients had radical mastectomy or conservative surgery with total axillary dissection: 461 patients of mean age 57.1 years (range: 25-89 years) were lymph-node positive (pN1); 369 patients (80%) had radical mastectomy; and 92 patients (20%) had conservative treatment plus post-operative radiotherapy, with the same mean number (n = 16) of lymph nodes collected in the surgical specimen. Data were analysed for the number of positive lymph nodes and level of involvement.
  
  
  RESULTS
  Level I, Levels I + II and Levels I + II + III were involved in 44.9, 18 and 21.4% of patients, respectively; 'skip metastases' occurred in 72 of 461 pN1 patients (15.5%). A univariate analysis showed that prognosis was directly related to the number of levels involved (P < 0.001), and skip metastases had the same prognostic role as Level I involvement. The numbers of involved lymph-node levels and metastatic lymph nodes were well correlated; multivariate analysis showed that involvement of Levels I and III was independently correlated with prognosis. After adjustment for age and number of positive lymph nodes, the number of involved lymph-node levels was an independent prognostic factor, with highest predictability when all three lymph-node levels were positive (P = 0.009).
  
  
  CONCLUSIONS
  The prognostic value of lymph-node status should be defined not only by the number of metastatic lymph nodes, but also by the number of levels of involvement.
authors.affiliation: Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro-Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Canavese
authors.forename: A
authors.initials: A
authors.lastname: Catturich
authors.forename: C
authors.initials: C
authors.lastname: Vecchio
authors.forename: D
authors.initials: D
authors.lastname: Tomei
authors.forename: M
authors.initials: M
authors.lastname: Gipponi
authors.forename: P
authors.initials: P
authors.lastname: Bruzzi
authors.forename: F
authors.initials: F
authors.lastname: Badellino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis