Abstract
investigated therelationbetweenlymphnodeinvolvementandageinalargedatabasefrom the University Hospital Leuven in Belgium. The risk of lymphnode involvement decreased with age up to the age of 70 years, butincreasedaftertheageof70years,andthisincreasewasmainlyseeninsmallertumors.Theage-relatedpatternoflymphnodeinvolve-mentcouldbereplicatedonanindependentpopulation-basedtumordatabasefromtheEindhovenCancerRegistryintheNetherlands.IntheirmethodsWildiersetalstatethat,forseveralreasons,ofthe3,549patientsintheLeuvendatabase,981wereexcludedfromtheanalyses,includinganunspecifiednumberofpatientswhoneverhadtherapy/surgery before for breast cancer. In the discussion, they state thatselection bias, if present, is probably limited, as axillary lymph nodedissection(ALND)wasnotperformedinonly48patients(1.4%),22ofthemolderthanage70years.However,tojudgepossibleselectionbias,itisalsoimportanttoknowthenumberofpatientsthatdidnotundergosurgeryatallforthedifferentagegroups.The validation data set of the Eindhoven Cancer Registry con-tained 3,234 patients, of whom 9.2% had missing values for axillarynodal status. It is not clear if these were the patients without axillarystaging or if nodal status was missing for other reasons. In apreviously published study, in which we were involved and thatwas also based on data from the Eindhoven Cancer Registry, theperformance of axillary lymph node staging was found to bestronglyrelatedtoage.
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