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Annals of Surgical Oncology

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01-11-2014 | Breast Oncology

Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

Authors: Stacy Ugras, MD, Michelle Stempel, MPH, Sujata Patil, PhD, Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 12/2014

Abstract

Background

The ACOSOG Z0011 trial demonstrated that axillary dissection (ALND) is not necessary for local control or survival in women with T1/2cN0 cancer undergoing breast-conserving therapy. There is concern about applying these results to triple-negative (TN) cancers secondary to their high local-recurrence (LR) rate. We examined the frequency of lymphovascular invasion (LVI) and nodal metastases in TN cancers to determine whether ALND can be safely avoided in this subtype.

Methods

Data were obtained from a database of patients with invasive breast cancer treated at Memorial Sloan Kettering Cancer Center from January 1998 to December 2010. A total of 11,596 tumors were classifiable into clinical surrogates for molecular subtype by immunohistochemical analysis: hormone receptor (HR)+/HER2+, HR+/HER2−, HR−/HER2+, and TN (HR−/HER2−). Multivariable logistic regression analysis (MVA) was used to determine associations between clinicopathologic variables and subtype.

Results

There were differences in age, tumor size, LVI, grade, and nodal involvement among groups. On MVA controlling for size, grade, and age, ER, PR, and HER2 status were significantly associated with LVI (p < 0.0001). Relative to TN tumors, HR+/HER2−, HR+/HER2+, and HR−/HER2+ tumors had higher odds of demonstrating LVI of 1.8 (odds ratio 1.8; 95 % confidence interval 1.6–2.1), 2.5 (2.5; 2.0–3.0), and 1.7 (1.7; 1.4–2.1), respectively. On MVA adjusting for size, grade, LVI, and age, TN tumors had the lowest odds of having any or high-volume nodal involvement (≥4 nodes, p < 0.0001).

Conclusions

LVI and nodal metastases were least frequent in TN cancers compared with other subtypes, despite the uniformly worse prognosis and increased LR rate in TN tumors. This suggests TN cancers spread via lymphatics less frequently than other subtypes and ALND may be avoided in TN patients meeting Z0011 eligibility criteria.

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Title: Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement
Authors: Stacy Ugras, MD
Michelle Stempel, MPH
Sujata Patil, PhD
Monica Morrow, MD
Publication date: 01-11-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3851-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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