title: Size of residual lymph node metastasis after neoadjuvant chemotherapy in locally advanced breast cancer patients is prognostic.
abstract: BACKGROUND
  The prognostic significance of micrometastasis after neoadjuvant chemotherapy for locally advanced breast cancer is unknown. We examined the residual lymph node metastasis size in patients after treatment with neoadjuvant chemotherapy to determine the relevance of metastasis size on outcome.
  
  
  METHODS
  Stage II/III breast cancer patients treated with neoadjuvant chemotherapy at our institution from 1991 to 2002 were included. We examined the relationship of postneoadjuvant chemotherapy lymph node metastasis size and number with distant disease-free survival (DDFS) and overall survival (OS).
  
  
  RESULTS
  In 122 patients with a median follow-up of 5.4 years, we found not only that patients with an increasing number of residual positive nodes had progressively worse DDFS and OS (P < .0001 for both) compared with patients with negative nodes, but also that the size of the largest lymph node metastasis was associated with worse DDFS and OS (P < .0001 for both) in both univariate and multivariate analysis. Compared with negative nodes, even lymph node micrometastasis (<2 mm) was associated with worsened DDFS and OS (adjusted P = .02 and P = .005, respectively).
  
  
  CONCLUSIONS
  Residual micrometastatic disease in the axillary lymph nodes after neoadjuvant chemotherapy is predictive of worse prognosis than negative nodes. In this study, the lymph node metastasis size and the number of involved lymph nodes were independent powerful predictors of DDFS and OS.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, 27599, USA. nancy_demore@med.unc.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Klauber-DeMore
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: Chad
authors.initials: C
authors.lastname: Livasy
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Calvo
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: E Claire
authors.initials: EC
authors.lastname: Dees
authors.forename: Carolyn I
authors.initials: CI
authors.lastname: Sartor
authors.forename: Lynda R
authors.initials: LR
authors.lastname: Sawyer
authors.forename: Mark
authors.initials: M
authors.lastname: Graham
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D020360:Neoadjuvant Therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis