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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2017

01-01-2017 | Epidemiology

The impact of nodal micrometastasis on mortality among women with early-stage breast cancer

Authors: Javaid Iqbal, Ophira Ginsburg, Vasily Giannakeas, Paula A. Rochon, John L. Semple, Steven A. Narod

Published in: Breast Cancer Research and Treatment | Issue 1/2017

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Abstract

Purpose

The clinical significance of nodal micrometastasis is debated. Our primary objective was to determine whether, among women with early-stage breast cancer, regional lymph node micrometastasis is an independent risk factor for mortality. The secondary objective was to identify subgroups of women who have the highest risk of death from early-stage breast cancer with micrometastases.

Methods

206,625 women diagnosed with early-stage breast cancer (IA, IB, and IIA) from 2004 to 2012 were identified in the Surveillance, epidemiology, and end results database. Nodal status was classified as node-negative, isolated-tumor cells, micrometastases, and macrometastases. Women were classified into eight ethnic groups. Logistic regression was performed to estimate the odds ratio of being diagnosed with micrometastases. The Cox proportional hazard model was used to estimate the hazard ratio (HR) of breast cancer-specific death associated with micrometastases for each ethnic group.

Results

The 8-year breast cancer-specific survival was 96.6 % for women with node-negative breast cancers and was 94.6 % for women with micrometastases (adjusted HR 1.49; 95 % CI 1.31–1.69; P < .001). Among women with micrometastases, the 8-year breast cancer-specific survival was 95.1 % for white women and was 90.6 % for black women (HR 1.80; 95 % CI 1.29–2.52; P = .0006).

Conclusion(s)

Nodal micrometastasis is an independent risk factor for breast cancer mortality among women with early-stage breast cancer. Black women are more likely to die from breast cancer with micrometastases than white women.
Appendix
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Literature
1.
Rosen PR, Groshen S, Saigo PE et al (1989) A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma. J Clin Oncol 7:355–366PubMed
2.
Fisher B, Redmond C, Dimitrov NV et al (1989) A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors. N Engl J Med 320:473–478CrossRefPubMed
3.
Mansour EG, Gray R, Shatila AH et al (1989) Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer. An intergroup study. N Engl J Med 320:485–490CrossRefPubMed
4.
EBCTCG, Breast E, Trialists C et al (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717CrossRef
5.
Bonadonna G, Valagussa P, Moliterni A et al (1995) Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. N Engl J Med 332:901–906CrossRefPubMed
6.
Fisher ER, Anderson S, Redmond C et al (1993) Pathologic findings from the national surgical adjuvant breast project protocol B-06. 10-year pathologic and clinical prognostic discriminants. Cancer 71:2507–2514CrossRefPubMed
7.
Veronesi U (1993) Prognostic significance of number and level of axillary node metastases in breast cancer. Breast 2:224–228CrossRef
8.
Fitzgibbons PL, Page DL, Weaver D et al (2000) Prognostic factors in breast cancer. College of american pathologists consensus statement 1999. Arch Pathol Lab Med 124:966–978PubMed
9.
Surveillance, epidemiology, and end results (SEER) program (www.​seer.​cancer.​gov) SEER*stat database: incidence—SEER 18 regs research data + hurricane katrina impacted Louisiana cases, Nov 2014 sub (1973–2012 varying)—Linked To County Attributes—Tota
10.
Reporting American Joint Committee on Cancer and End-Results (1977) Manual for staging of cancer, 1st edn. J.B. Lippincott, Philadelphia
11.
Greene FL, Page DL, Fleming ID et al (2002) E: AJCC cancer staging manual, 6th edn. Springer, New YorkCrossRef
12.
Mittendorf EA, Ballman KV, McCall LM et al (2015) Evaluation of the stage IB designation of the American joint committee on cancer staging system in breast cancer. J Clin Oncol 33:1119–1127CrossRefPubMed
13.
Giuliano AE, Hawes D, Ballman KV et al (2011) Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA 306:385–393CrossRefPubMed
14.
Tan LK, Giri D, Hummer AJ et al (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 26:1803–1809CrossRefPubMed
15.
de Boer M, van Deurzen CHM, van Dijck JAAM et al (2009) Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med 361:653–663CrossRefPubMed
16.
Joslyn SA, Konety BR (2005) Effect of axillary lymphadenectomy on breast carcinoma survival. Breast Cancer Res Treat 91:11–18CrossRefPubMed
17.
Nurgalieva ZZ, Franzini L, Morgan RO et al (2013) Utilization of lymph node dissection, race/ethnicity, and breast cancer outcomes. Am J Manag Care 19:805–810PubMed
18.
Chen SL, Hoehne FM, Giuliano AE (2007) The prognostic significance of micrometastases in breast cancer: a SEER population-based analysis. Ann Surg Oncol 14:3378–3384CrossRefPubMed
19.
Maibenco DC, Dombi GW, Kau TY et al (2006) Significance of micrometastases on the survival of women with T1 breast cancer. Cancer 107:1234–1239CrossRefPubMed
20.
Kimbrough CW, McMasters KM, Quillo A et al (2015) Occult metastases in node-negative breast cancer: a surveillance, epidemiology, and end results-based analysis. Surgery 158:494–500CrossRefPubMed
21.
22.
Querzoli P, Pedriali M, Rinaldi R et al (2006) Axillary lymph node nanometastases are prognostic factors for disease-free survival and metastatic relapse in breast cancer patients. Clin Cancer Res 12:6696–6701CrossRefPubMed
23.
Cunningham JE, Montero AJ, Garrett-Mayer E et al (2010) Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status. Cancer Causes Control 21:399–409CrossRefPubMed
24.
Maskarinec G, Sen C, Koga K et al (2011) Ethnic differences in breast cancer survival: status and determinants. Womens Health 7:677–687
25.
Aziz H, Hussain F, Sohn C et al (1999) Early onset of breast carcinoma in African American women with poor prognostic factors. Am J Clin Oncol 22:436–440CrossRefPubMed
26.
Silber JH, Rosenbaum PR, Clark AS et al (2013) Characteristics associated with differences in survival among black and white women with breast cancer. JAMA 310:389–397CrossRefPubMed
27.
Iqbal J, Ginsburg O, Rochon PA et al (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313:165–173CrossRefPubMed
28.
29.
Schnitt SJ (2010) Classification and prognosis of invasive breast cancer: from morphology to molecular taxonomy. Mod Pathol 23(Suppl 2):S60–S64CrossRefPubMed
30.
Cote RJ, Peterson HF, Chaiwun B, International Breast Cancer Study Group et al (1999) Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. Lancet 354:896–900CrossRefPubMed
31.
Wasif N, Ye X, Giuliano AE (2009) Survey of ASCO members on management of sentinel node micrometastases in breast cancer: variation in treatment recommendations according to specialty. Ann Surg Oncol 16:2442–2449CrossRefPubMed
32.
Metadata
Title
The impact of nodal micrometastasis on mortality among women with early-stage breast cancer
Authors
Javaid Iqbal
Ophira Ginsburg
Vasily Giannakeas
Paula A. Rochon
John L. Semple
Steven A. Narod
Publication date
01-01-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-016-4015-5

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