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Grand Rounds

Is Distant Lymph Node Metastases of Breast Cancer a Regional Disease?

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BACKGROUND AND PURPOSE:

  • There are few studies exploring whether the location of lymph node metastasis in breast cancer impacts the survival of patients
  • Pan et al. (JAMA, 2021) assessed the survival of patients with distant lymph node metastases (DLNM) versus ipsilateral supraclavicular lymph node metastases (ISLM) in stage IV breast cancer

METHODS:

  • Cohort study
  • Data source
    • SEER database
  • Participants
    • Patients diagnosed with breast cancer between January 1, 2010 and December 31, 2014
    • Three groups of patients were included
      • ISLM without any distant metastasis
      • DLNM
      • Distant metastasis (DLNM excluded)
  • Exposures
    • Surgery for primary tumor
    • Surgery for distant lymph nodes
    • Radiotherapy
  • Primary outcomes
    • Overall survival (OS)
    • Breast cancer-specific survival (BCSS)

RESULTS:

  • 2033 women
    • Mean age: 62.03 years; 74% White
    • ISLM: 10.4%
    • DLNM: 27.0%
    • Distant metastases: 72.6%
  • 3-year breast cancer specific survival rates
    • ISLM: 63.24%
    • DLNM: 64.54%
    • Distant: 41.20%
  •  3-year overall survival rates
    • ISLM: 53.46%
    • DLNM: 62.67%
    • Distant: 38.21%
  • Compared with patients with ISLM, patients with DLNM had similar survival rates, but patients with distant metastases had significantly poorer outcomes
    • Patients with DLNM
      • BCSS: Hazard ratio (HR) 0.81 (95% CI, 0.52 to 1.25; P = 0.34)
      • OS: HR 0.73 (95% CI, 0.51 to 1.05; P = 0.09)
    • Patients with distant metastases
      • BCSS: HR 1.99 (95% CI, 1.43 to 2.78; P < 0.001)
      • OS: HR 1.79 (95% CI, 1.35 to 2.38; P < 0.001)
  • Locoregional treatment: For DLNM, primary surgery and radiotherapy were associated with improved overall survival rates
    • Primary surgery: HR 0.21 (95% CI, 0.12 to 0.39; P < 0.001)
    • Radiotherapy: HR 0.46 (95% CI, 0.25 to 0.87; P = 0.02)

CONCLUSION:

  • Distant lymph node metastases of breast cancer might be a regional disease and have survival rates similar to ipsilateral supraclavicular lymph node metastases
  • The authors recognize a significant limitation to this study is the retrospective design
  • The authors conclude that although more studies are needed to confirm their findings

…breast cancer with DLNM may be a curable disease, similar to N3c disease, with a significantly better prognosis than other types of stage IV disease

Locoregional treatment was associated with significantly improved survival for patients with DLNM

Learn More – Primary Sources:

Comparison of Survival Outcomes Among Patients With Breast Cancer With Distant vs Ipsilateral Supraclavicular Lymph Node Metastases

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Related ObG Topics:

Breast Cancer Recurrence Risks Following Endocrine Therapy – 20 Years Out
TAILORx Results: Can a Gene-Expression Test Help Determine if Some Women with Breast Cancer Can Safely Avoid Chemotherapy?
More from the WHI: Are Breast Cancers That Develop Between Mammograms Associated with Worse Survival Outcomes?

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