title: The prognostic impact of occult nodal metastasis in early breast carcinoma.
abstract: The clinical relevance of isolated tumor cell (ITC: <or=0.2 mm) and micrometastasis (MM: >0.2-2.0 mm) in axillary lymph nodes (ALNs) remains unknown. The aim of this study was to determine their prognostic significance. A total of 295 patients considered as pN0 after routine histological assessment, were reevaluated with ten-level cytokeratin immunohistochemistry (IHC) and two-level hematoxylin-eosin sections. Survival rates, i.e. disease-free survival (DFS), distant disease-free survival (DDFS) and breast cancer specific survival (BCSS) were compared with those of reevaluated node-negative patients. A total of 84 patients (28%) had ITC/MM identified on IHC sections. ITC had no impact on survival at a median 8.2 years of follow-up, whereas MM showed a trend toward poorer DFS (P = 0.091, log rank) and DDFS (P = 0.066) and significantly reduced BCSS (P = 0.016). In multivariate analyses, detection of MM was an independent prognostic factor for DDFS (P = 0.025) and BCSS (P = 0.01) in adjuvant un-treated patients. Micrometastases (MMs) in axillary lymph nodes have prognostic impact. This was not found for ITC. This finding supports the use of systemic adjuvant therapy in patients with MM.
authors.affiliation: Department of Pathology, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0407, Oslo, Norway. daehoon.park@ulleval.no
authors.forename: Daehoon
authors.initials: D
authors.lastname: Park
authors.forename: Rolf
authors.initials: R
authors.lastname: Kåresen
authors.forename: Bjørn
authors.initials: B
authors.lastname: Naume
authors.forename: Marit
authors.initials: M
authors.lastname: Synnestvedt
authors.forename: Elsa
authors.initials: E
authors.lastname: Beraki
authors.forename: Torill
authors.initials: T
authors.lastname: Sauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001365:Axilla; D001853:Bone Marrow / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008408:Mastectomy; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D013629:Tamoxifen / Q000008:administration & dosage
chemical_list: D013629:Tamoxifen; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate