title: Internal mammary lymph node metastasis in breast cancer: predictive models to assist with prognostic influence.
abstract: BACKGROUND
  Metastatic breast cancer in the internal mammary nodes (IMN) indicates a poor prognosis. Several recent epidemiological surveys have determined a reduction in survival for patients with medial compared to lateral sector tumors attributing this to a higher rate of unrecognized IMN metastasis and hence these patients are undertreated with adjuvant therapy.(1-6)
  
  
  OBJECTIVE
  Through mathematical modeling based on large datasets we aim to quantify the impact on survival of IMN metastases at different tumor and axillary stages.
  
  
  METHODS
  Mathematical models were created to estimate the survival of patients with and without IMN metastasis. It was assumed that the different rate of survival between medial and lateral sector breast cancers was a result of the differential rate of unrecognized IMN metastases with resultant under-staging and under treatment. We applied these models on a retrospective database analysis from the Surveillance, Epidemiology and End-Results (SEER) registries from 1994 to 2003.
  
  
  RESULTS
  The 10-year odds of death (OOD) from breast cancer for patients with medial compared with lateral sector tumors ranged from 1.2 to 1.5 depending on stage. The predicted odds of breast cancer death for patients with unrecognized IMN metastases ranged from 2.4 to 20, with the highest OOD in the groups with small tumors and no axillary node metastasis.
  
  
  CONCLUSIONS
  Through modeling we have been able to predict and quantify the significantly worse survival outcomes for patients with undiagnosed IMN metastasis.
authors.affiliation: Department of Surgical Oncology, Mater and Royal North Shore Hospital, University of Sydney, Lindfield, NSW 2071, Sydney, Australia. fnoushi@med.usyd.edu.au
authors.forename: F
authors.initials: F
authors.lastname: Noushi
authors.forename: A J
authors.initials: AJ
authors.lastname: Spillane
authors.forename: R F
authors.initials: RF
authors.lastname: Uren
authors.forename: V
authors.initials: V
authors.lastname: Gebski
mesh_terms: D001940:Breast; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008954:Models, Biological; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program