Abstract
Background. Metastatic involvement of the internal mammary chain lymph nodes (IMN) is associated with poor prognosis for breast cancer (BC) patients. However, parasternal radiation therapy is still a subject for debate. Methods. Results of 1144 consecutively treated patients with primary BC, who underwent one-stage videothoracoscopic (VATS) parasternal lymphadenectomy from 1998 to 2009, were retrospectively studied. Results. Surgical complications associated with thoracoscopic procedure did not exceed 2%. IMN metastases were detected in 211 (18.4%) patients, 6.0% of these cases did not have axillary invasion. In a wide analysis, the frequency of metastasis was statistically more influenced by: tumor localization (different from external quadrants), primary tumor size (T), level of involved axillary lymph nodes (N) and lymphovascular invasion. Patients with IMN metastases showed significantly poorer long-term outcomes: 5-year overall - OS and disease-free survival - DFS (OS 79.0±3.1% vs 91.4±1.0%, p<0.001; DFS 69.0±3.4% vs 86.0±1.2%, p<0.001, respectively) both in the whole group and in the subgroups with and without axillary lymph node metastases. IMN metastases along with tumor size and axillary nodes showed a negative independent prognostic influence on the DFS and OS (hazard ratio 2.24 [1.45-3.46]; 2.50 [1.41-4.43], respectively). Conclusions. IMN status is an important criterion which may influence on the prognosis and adjuvant treatment strategy in BC. Our study is in favor of conducting randomized clinical studies supporting the impact of radiotherapy treatment for involved IMN.
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