The impact of isolated tumor cells on loco-regional recurrence in breast cancer patients treated with breast-conserving treatment or mastectomy without post-mastectomy radiation therapy
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To compare the outcome of patients with invasive breast cancer, who had isolated tumor cells (ITC) in sentinel lymph nodes, pN0(i+), to patients with histologically negative nodes, pN0. We retrospectively studied 1,273 patients diagnosed with T1–T3 breast cancer from 1999 to 2009. Patients were divided into 2 populations: 807 patients treated with breast-conserving surgery (BCS) and radiotherapy (RT), 85(10.5 %) with pN0(i+) and 722(89.5 %) with pN0. And the other population had 466 patients treated with mastectomy without post-mastectomy radiation therapy (PMRT), 80(17.2 %) with pN0(i+),and 386(82.8 %)with pN0. All patients underwent sentinel node biopsy, and the presence of ITC was determined. Patients with axillary dissection only or neoadjuvant chemotherapy were excluded. Among the 1,273 patients studied; 87.3 % received adjuvant systemic therapy. Kaplan–Meier, Cox regression, and log-rank statistical tests were used. Median patient age was 55.7 years. Median follow-up was 69.5 months. The 5- and 10-year cumulative incidence of Loco-regional recurrence (LRR) for patients treated with BCS and RT was 1.6 and 3.5 % for 85 pN0(i+) patients, and 2.4 and 5 % for 722 pN0 patients, respectively. For patients treated with mastectomy without PMRT, 5- and 10-year LRR rates were 2.8 and 2.8 % for 80 pN0(i+) patients, and 1.8 and 3 % for 386 pN0 patients, respectively. There were no statistically significant differences in LRR (p = 0.9), distant recurrence (p = 0.3) ,and overall survival (p = 0.5) among all groups. On multivariate analysis, ITC were not associated with increased risk of LRR, distant recurrence and overall survival. Grade (p = 0.003) and systemic therapy (p = 0.02) were statistically significantly associated with risk of LRR. Sentinel node ITC have no significant impact on LRR, distant recurrence and overall survival in breast cancer patients. Additional treatments such as axillary dissection, chemotherapy, or regional radiation should not be given solely based on the presence of sentinel node ITC.
KeywordsIsolated tumor cells (ITC) Breast cancer Outcome
We would like to acknowledge Rano M. Faltas, MD and Boshra F. Louka, MD for their help in the writing of this manuscript.
Conflicts of interest
No conflict of interest to disclose for all authors.
- 2.Giuliano AE (1996) Sentinel lymphadenectomy in primary breast carcinoma: an alternative to routine axillary dissection. J Surg Oncol 62(2):75–77. doi: 10.1002/(SICI)1096-9098(199606)62:2<75:AID-JSO1>3.0.CO;2-N PubMedCrossRefGoogle Scholar
- 3.Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, McCall LM, Morrow M (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA, J Am Med Assoc 305(6):569–575. doi: 10.1001/jama.2011.90 CrossRefGoogle Scholar
- 4.Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, Shenouda MN, O’Toole JA, Macdonald SM, Specht MC, Taghian AG (2014) The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys 88(3):565–571. doi: 10.1016/j.ijrobp.2013.11.232 PubMedCrossRefGoogle Scholar
- 8.Pugliese MS, Beatty JD, Tickman RJ, Allison KH, Atwood MK, Szymonifka J, Arthurs ZM, Huynh PP, Dawson JH (2009) Impact and outcomes of routine microstaging of sentinel lymph nodes in breast cancer: significance of the pN0(i+) and pN1mi categories. Ann Surg Oncol 16(1):113–120. doi: 10.1245/s10434-008-0121-x PubMedCrossRefGoogle Scholar
- 9.Colleoni M, Rotmensz N, Peruzzotti G, Maisonneuve P, Mazzarol G, Pruneri G, Luini A, Intra M, Veronesi P, Galimberti V, Torrisi R, Cardillo A, Goldhirsch A, Viale G (2005) Size of breast cancer metastases in axillary lymph nodes: clinical relevance of minimal lymph node involvement. J Clin Oncol 23(7):1379–1389. doi: 10.1200/JCO.2005.07.094 PubMedCrossRefGoogle Scholar
- 10.de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, Nortier JW, Rutgers EJ, Seynaeve C, Menke-Pluymers MB, Bult P, Tjan-Heijnen VC (2009) Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med 361(7):653–663. doi: 10.1056/NEJMoa0904832 PubMedCrossRefGoogle Scholar
- 11.Degnim AC, Zakaria S, Boughey JC, Sookhan N, Reynolds C, Donohue JH, Farley DR, Grant CS, Hoskin T (2010) Axillary recurrence in breast cancer patients with isolated tumor cells in the sentinel lymph node [AJCC N0(i+)]. Ann Surg Oncol 17(10):2685–2689. doi: 10.1245/s10434-010-1062-8 PubMedCrossRefGoogle Scholar
- 12.Maaskant-Braat AJ, van de Poll-Franse LV, Voogd AC, Coebergh JW, Roumen RM, Nolthenius-Puylaert MC, Nieuwenhuijzen GA (2011) Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study. Breast Cancer Res Treat 127(1):195–203. doi: 10.1007/s10549-010-1086-6 PubMedCrossRefGoogle Scholar
- 13.Montagna E, Viale G, Rotmensz N, Maisonneuve P, Galimberti V, Luini A, Intra M, Veronesi P, Mazzarol G, Pruneri G, Renne G, Torrisi R, Cardillo A, Cancello G, Goldhirsch A, Colleoni M (2009) Minimal axillary lymph node involvement in breast cancer has different prognostic implications according to the staging procedure. Breast Cancer Res Treat 118(2):385–394. doi: 10.1007/s10549-009-0446-6 PubMedCrossRefGoogle Scholar
- 14.Reed J, Rosman M, Verbanac KM, Mannie A, Cheng Z, Tafra L (2009) Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 208(3):333–340. doi: 10.1016/j.jamcollsurg.2008.10.036 PubMedCrossRefGoogle Scholar
- 15.Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, Hudis C, Borgen PI, Cody HS 3rd (2008) Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol 26(11):1803–1809. doi: 10.1200/JCO.2007.12.6425 PubMedCrossRefGoogle Scholar
- 17.Taghian A, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, Wolmark N (2004) Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 22(21):4247–4254. doi: 10.1200/JCO.2004.01.042 PubMedCrossRefGoogle Scholar