Abstract
IntroductionKnowledge of the association between isolated tumor cells (ITCs) in breast cancer patients and the outcome is very limited. We aimed to determine the prognostic value of axillary lymph node ITCs for T1N0M0 female breast cancer (FBC) patients.MethodsData for T1N0M0 FBC patients staged ITCs negative [pN0(i−)] and positive [pN0(i+)] were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Prognostic predictors were identified by Kaplan–Meier analysis, competing risk model, and Fine–Gray multivariable regression model.ResultsA total of 94,599 subjects were included, 88,632 of whom were staged at pN0(i−) and 5,967 were pN0(i+). Patients staged pN0(i+) had worse breast cancer-specific survival (BCSS) [hazard ratio (HR): 1.298, 95% CI = 1.069–1.576, P = 0.003] and higher breast cancer-specific death (BCSD) rate (Gray’s test, P = 0.002) than pN0(i−) group. In the Fine–Gray multivariable regression analysis, the pN0(i+) group had higher BCSD rate (HR: 1.321, 95% CI = 1.109–1.575, P = 0.002) than pN0(i−) group. In subgroup analyses, no significant difference in BCSD was shown between the chemotherapy and non-chemotherapy subgroup (Gray’s test, P = 0.069) or radiotherapy and non-radiotherapy subgroup (Gray’s test, P = 0.096).ConclusionITC was independently related to the increase of the BCSD rate and could be identified as a reliable survival predictor for T1N0M0 FBC patients.
Highlights
Knowledge of the association between isolated tumor cells (ITCs) in breast cancer patients and the outcome is very limited
Patients staged pN0(i+) had worse breast cancerspecific survival (BCSS) [hazard ratio (HR): 1.298, 95% confidence interval (CI) = 1.069–1.576, P = 0.003] and higher breast cancer-specific death (BCSD) rate (Gray’s test, P = 0.002) than pN0(i−) group
In the Fine–Gray multivariable regression analysis, the pN0(i+) group had higher BCSD rate (HR: 1.321, 95% CI = 1.109–1.575, P = 0.002) than pN0(i−) group
Summary
Knowledge of the association between isolated tumor cells (ITCs) in breast cancer patients and the outcome is very limited. We aimed to determine the prognostic value of axillary lymph node ITCs for T1N0M0 female breast cancer (FBC) patients. Isolated tumor cells (ITCs), proposed by Saphir and Amromin [1] as occult metastasis of axillary lymph nodes in breast cancer, were defined as the single tumor cell or tumor-cell cluster with a maximum diameter of no more than 0.2 mm. If neither H&E nor immunohistochemical (IHC) staining detects the presence of tumor cells in the lymph node, the N stage is classified as pN0(i−). If ITC is found in lymph node according to H&E or IHC staining, the N stage is defined as pN0(i+). More studies are urgently needed to confirm the realworld curative effect of lymph node ITCs in patients with female breast cancer (FBC)
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