title: Lymphovascular invasion is associated with reduced locoregional control and survival in women with node-negative breast cancer treated with mastectomy and systemic therapy.
abstract: BACKGROUND
  The impact of lymphovascular invasion (LVI) on postmastectomy locoregional relapse (LRR) and its use in guiding locoregional therapy in node-negative breast cancer are unclear. This study evaluates the association of LVI with relapse and survival in a cohort of women with early-stage breast cancer.
  
  
  METHODS
  The study cohort comprised 763 women with pT1-2, pN0 breast cancer referred from 1989 to 1999 and treated with mastectomy and adjuvant systemic therapy without radiotherapy. Kaplan-Meier LRR, distant relapse, and overall survival rates at 7 years were compared between patients with and without LVI. Cox regression analyses were performed to evaluate the prognostic significance of LVI for relapse and survival.
  
  
  RESULTS
  Median followup was 7.0 years (range 0.34 to 14.9 years). LVI was present in 210 (27.5%) patients. In log-rank comparisons of Kaplan-Meier curves stratified by LVI status, LVI-positive disease was associated with significantly higher risks of LRR (p = 0.006), distant relapse (p = 0.04), and lower overall survival (p = 0.02). In the multivariable Cox regression analysis, LVI was significantly associated with LRR (relative risk [RR] = 2.32; 95% CI, 1.26-4.27; p = 0.007), distance relapse (RR = 1.53; 95% CI, 1.00-2.35; p = 0.05), and overall survival (RR = 1.46; 95% CI, 1.04-2.07; p = 0.03). In patients with one of the following characteristics: age younger than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, 7-year LRR risks increased threefold from 3% to 5% when LVI was absent, to 15% to 20% in the presence of LVI.
  
  
  CONCLUSIONS
  LVI is an adverse prognostic factor for relapse and survival in node-negative patients treated with mastectomy and systemic therapy. LVI, in combination with age older than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, identified patient subsets with 7-year LRR risks of approximately 15% to 20%. Prospective research is required to define the role of adjuvant radiotherapy in these patients.
authors.affiliation: British Columbia Cancer Agency-Vancouver Island Centre and the Department of Surgery, University of British Columbia, Victoria, BC, Canada.
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Celina M
authors.initials: CM
authors.lastname: Yong
authors.forename: Freddy
authors.initials: F
authors.lastname: Abnousi
authors.forename: Junella
authors.initials: J
authors.lastname: Lee
authors.forename: Hosam A
authors.initials: HA
authors.lastname: Kader
authors.forename: Allen
authors.initials: A
authors.lastname: Hayashi
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017697:Premenopause; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D015996:Survival Rate
chemical_list: D011960:Receptors, Estrogen