Abstract

BackgroundThe prognostic significance of isolated tumour cells (ITCs) in the sentinel nodes (SNs) is controversial in early breast cancer, and some centres have abandoned immunohistochemistry to detect ITCs.MethodsPatients with unilateral pT1N0 breast cancer, operated between February 2001 and August 2005 at a university hospital were included in this prospective, population-based cohort study. Survival of 936 patients with or without isolated tumour cells (ITC) in their SNs were compared with the log-rank test and Cox regression analysis.ResultsEight hundred sixty one (92.0%) patients were ITC-negative (pN0i−) and 75 (8.0%) ITC-positive (pN0i+). Patients with ITC-positive cancer received more frequently adjuvant systemic therapies than those with ITC-negative cancer. The median follow-up time was 9.5 years. Ten-year distant disease-free survival was 95.3% in the pN0i− group and 88.8% in the pN0i+ group (P = 0.013). ITCs were an independent prognostic factor in a Cox regression model (HR = 2.34, 95% CI 1.09–5.04; P = 0.029), together with tumour Ki-67 proliferation index and diameter. ITCs were associated with unfavourable overall survival (P = 0.005) and breast cancer-specific survival (P = 0.001).ConclusionsWe conclude that presence of ITCs in the SNs is an adverse prognostic factor in early small node-negative breast cancer, and may be considered in the decision-making for adjuvant therapy.

Highlights

  • The regional lymph node status has long been known to be an important prognostic factor in early breast cancer.[1]

  • In the beginning of the sentinel nodes (SNs) era, even the detection of small tumour deposits in the lymph nodes led to axillary lymph node dissection (ALND), but data from clinical trials and other evidence indicates that ALND does not improve survival of patients with limited SN involvement.[7,8,9]

  • We found that the presence of isolated tumour cells (ITCs) in the SNs was an independent predictor of distant recurrence in this cohort of patients with pT1 node-negative early breast cancer

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Summary

Introduction

The regional lymph node status has long been known to be an important prognostic factor in early breast cancer.[1]. The prognostic significance of isolated tumour cells (ITCs) in the sentinel nodes (SNs) is controversial in early breast cancer, and some centres have abandoned immunohistochemistry to detect ITCs. METHODS: Patients with unilateral pT1N0 breast cancer, operated between February 2001 and August 2005 at a university hospital were included in this prospective, population-based cohort study. CONCLUSIONS: We conclude that presence of ITCs in the SNs is an adverse prognostic factor in early small node-negative breast cancer, and may be considered in the decision-making for adjuvant therapy

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