Internal mammary lymph node recurrence: rare but characteristic metastasis site in breast cancer.
BACKGROUND
To assess the frequency of IMLN recurrence, its associated risk factors with disease-free interval (DFI) and its predicting factors on overall survival time.


METHODS
133 cases of breast cancer IMLN recurrence were identified via the computerized CT reporting system between February 2003 and June 2008, during which chest CT for patients with breast cancer (n = 8867) were performed consecutively at Cancer Hospital, Fudan University, Shanghai, China. Patients' charts were retrieved and patients' characteristics, disease characteristics, and treatments after recurrence were collected for analysis. The frequency was 1.5% (133/8867).


RESULTS
IMLN recurrence was presented as the first metastatic site in 121 (91%) patients while 88 (66.2%) had other concurrent metastases. Typical chest CT images included swelling of the IMLN at the ipsilateral side with local lump and sternal erosion located mostly between the second and third intercostal space. The median disease-free interval (DFI) of IMLN recurrence was 38 months. The independent factors that could delay the IMLN recurrence were small tumor size (HR 0.5 95%CI: 0.4 - 0.8; p = 0.002), and positive ER/PR disease (HR 0.6, 95% CI: 0.4 - 0.9; p = 0.006). The median survival time after IMLN recurrence was 42 months, with a 5-year survival rate of 30%. Univariate analysis showed four variables significantly influenced the survival time: DFI of IMLN recurrence (p = 0.001), no concurrent distant metastasis (p = 0.024), endocrine therapy for patients with positive ER/PR (p = 0.000), radiotherapy (p = 0.040). The independent factors that reduced the death risk were no concurrent distant metastases (HR: 0.7, 95% CI: 0.4 - 0.9; p = 0.031), endocrine therapy for patients with positive ER/PR status (HR: 0.2, 95% CI: 0.1 - 0.5; p = 0.001) and palliative radiotherapy (HR: 0.3, 95% CI: 0.1- 0.9; p = 0.026).


CONCLUSIONS
The risk of IMLN recurrence is low and there are certain characteristics features on CT images. ER/PR status is both a risk factor for DFI of IMLN recurrence and a prognostic factor for overall survival after IMLN recurrence. Patients with only IMLN recurrence and/or local lesion have a good prognosis.
Chen
Lei
L
Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai Medical College, Shanghai, PR China.
Gu
Yajia
Y
Leaw
Shiangjiin
S
Wang
Zhonghua
Z
Wang
Peihua
P
Hu
Xichun
X
Chen
Jiayi
J
Lu
Jingsong
J
Shao
Zhimin
Z
D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000628:therapy; D018276:Carcinoma, Medullary / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
Cancer. 1993 Mar 1;71(5):1774-9
8448741
Eur J Cancer. 2002 Sep;38(14):1860-70
12204668
Breast Cancer Res Treat. 2005 Feb;89(3):271-5
15754126
Lancet. 1999 May 15;353(9165):1641-8
10335782
Cancer. 1981 Jan 1;47(1):170-5
7459805
Cancer. 1976 Jan;37(1):206-14
1247957
Int J Radiat Oncol Biol Phys. 1999 Jan 1;43(1):25-38
9989511
Cancer. 2005 Aug 1;104(3):479-90
15968686
Ann Surg. 2001 Jul;234(1):79-84
11420486
Cancer. 1977 Feb;39(2):533-8
837336
Clin Imaging. 1991 Oct-Dec;15(4):268-72
1742676
Ann Surg Oncol. 2003 Oct;10(8):935-41
14527914
Cancer. 1999 Apr 15;85(8):1773-81
10223572
Ann Surg Oncol. 2001 Apr;8(3):234-40
11314940
Clin Nucl Med. 2003 Jul;28(7):558-64
12819408
N Engl J Med. 1997 Oct 2;337(14):956-62
9309100
J Clin Oncol. 2008 Oct 20;26(30):4981-9
18711171
Int J Radiat Oncol Biol Phys. 1989 Oct;17(4):703-10
2550398
Br Med J. 1954 Jan 9;1(4853):61-3
13106471
J Am Coll Surg. 2001 Nov;193(5):547-55
11708513
Am J Roentgenol Radium Ther Nucl Med. 1971 Jan;111(1):130-6
5540919
Eur J Cancer. 2005 Nov;41(17):2637-44
16115758
Cancer. 2003 Nov 15;98(10):2144-51
14601083
N Engl J Med. 1989 Feb 23;320(8):479-84
2644532
Breast Cancer Res Treat. 2008 Feb;107(3):379-87
17457670
Ann Surg Oncol. 2007 Apr;14(4):1486-92
17253106
N Engl J Med. 1989 Feb 23;320(8):473-8
2644531
Cancer. 1989 May 15;63(10):1912-7
2702564
Eur J Cancer. 1999 Sep;35(9):1320-5
10658521
Eur J Surg Oncol. 1987 Aug;13(4):309-14
3305080