Axillary lymph node micrometastases decrease triple-negative early breast cancer survival.
BACKGROUND
Triple-negative breast cancers (TNBCs) are the most deadly form of breast cancer (BC) subtypes. Axillary lymph node involvement (ALNI) has been described to be prognostic in BC taken as a whole, but its prognostic value in each subtype is unclear. We explored the prognostic impact of ALNI and especially of small size axillary metastases in early TNBCs.


METHODS
We analysed in this multicentre study all patients treated for early TNBC in 12 French cancer centres. We explored the correlation between clinicopathological data and ALNI, with a specific focus on the dichotomisation between macrometastases and occult metastases, which is defined as the presence of isolated tumour cells or micrometastases. The prognostic value of ALNI both in terms of disease-free survival (DFS) and overall survival (OS) was also explored.


RESULTS
We included 1237 TNBC patients. Five-year DFS and OS were 83.7% and 88.5%, respectively. The identified independent prognostic features for DFS were tumour size >20 mm (hazard ratio (HR)=1.86; 95% CI: 1.11-3.10, P=0.018), lymphovascular invasion (HR=1.69; 95% CI: 1.21-2.34, P=0.002) and ALNI both in case of macrometastases (HR=1.97; 95% CI: 1.38-2.81, P<0.0001) and occult metastases (HR=1.72; 95% CI: 1.1-2.71, P=0.019). DFS and OS were similar between tumours with occult metastases and macrometastases. Tumours presenting at least two pejorative features (out of ALNI, lymphovascular invasion and large tumour size) displayed a significantly poorer DFS in both the training set and validation set, independently of chemotherapy administration. Tumours with no more than one of the above-cited pejorative features had a 5-year OS of ⩾90% vs 70% for other cases (P<0.0001).


CONCLUSIONS
Axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumour cells were identified in lymph nodes. This impact is independent of chemotherapy use.
Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France.
G
G
Houvenaeghel
Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France.
R
R
Sabatier
Institut Curie, Paris, France.
F
F
Reyal
Institut René Gauducheau, Site hospitalier Nord, St Herblain, France.
J M
JM
Classe
Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France.
S
S
Giard
Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France.
H
H
Charitansky
Centre René Huguenin, 35 rue Dailly, Saint Cloud, France.
R
R
Rouzier
Centre Léon Bérard, 28 rue Laennec, Lyon, France.
C
C
Faure
Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France.
J R
JR
Garbay
Hôpital Tenon, 4 rue de la Chine, Paris, France.
E
E
Daraï
Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France.
D
D
Hudry
Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France.
P
P
Gimbergues
Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France.
R
R
Villet
Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France.
E
E
Lambaudie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*
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