title: Internal mammary lymph node recurrence: rare but characteristic metastasis site in breast cancer.
abstract: 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.
authors.affiliation: Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai Medical College, Shanghai, PR China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Yajia
authors.initials: Y
authors.lastname: Gu
authors.forename: Shiangjiin
authors.initials: S
authors.lastname: Leaw
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Wang
authors.forename: Peihua
authors.initials: P
authors.lastname: Wang
authors.forename: Xichun
authors.initials: X
authors.lastname: Hu
authors.forename: Jiayi
authors.initials: J
authors.lastname: Chen
authors.forename: Jingsong
authors.initials: J
authors.lastname: Lu
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Shao
mesh_terms: 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
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