Originally published as JCO Early Release 10.1200/JCO.2006.09.8152 on April 9 2007

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Karlsson, P. Articles by Wallgren, A. Search for Related Content PubMed PubMed Citation Articles by Karlsson, P. Articles by Wallgren, A. Social Bookmarking                            What's this?

The Role of the Number of Uninvolved Lymph Nodes in Predicting Locoregional Recurrence in Breast Cancer

Per Karlsson, Bernard F. Cole, Karen N. Price, Alan S. Coates, Monica Castiglione-Gertsch, Barry A. Gusterson, Elizabeth Murray, Jurij Lindtner, John P. Collins, Stig B. Holmberg, Martin F. Fey, Beat Thürlimann, Diana Crivellari, John F. Forbes, Richard D. Gelber, Aron Goldhirsch, Arne Wallgren

From the Department of Oncology, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden; International Breast Cancer Study Group (IBCSG) Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health; Frontier Science and Technology Research Foundation, Boston, MA; Dartmouth Medical School, Lebanon, NH; Inselspital; IBCSG, Bern; Senology Center of Eastern Switzerland, Kantonsspital, St Gallen; Oncology Institute of Southern Switzerland, Bellinzona; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University of Sydney, Sydney; Department of Surgery, Royal Melbourne Hospital, Victoria; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle, New South Wales, Australia; Division of Cancer Sciences and Molecular Pathology, Western Infirmary, University of Glasgow, Glasgow, United Kingdom; Groote Shuur Hospital and University of Cape Town, Cape Town, South Africa; The Institute of Oncology, Ljubljana, Slovenia; Centro di Riferimento Oncologico, Aviano; and European Institute of Oncology, Milan, Italy

Address reprint requests to Per Karlsson, MD, Department of Oncology, University of Göteborg, Sahlgrenska University Hospital, S 413 45 Göteborg, Sweden; e-mail: per.karlsson{at}oncology.gu.se

Purpose To identify groups of early breast cancer patients with substantial risk (10-year risk > 20%) for locoregional failure (LRF) who might benefit from postmastectomy radiotherapy (RT).

Patients and Methods Prognostic factors for LRF were evaluated among 6,660 patients (2,588 node-negative patients, 4,072 node-positive patients) in International Breast Cancer Study Group Trials I to IX treated with chemotherapy and/or endocrine therapy, and observed for a median of 14 years. In total, 1,251 LRFs were detected. All patients were treated with mastectomy without RT.

Results No group with 10-year LRF risk exceeding 20% was found among patients with node-negative disease. Among patients with node-positive breast cancer, increasing numbers of uninvolved nodes were significantly associated with decreased risk of LRF, even after adjustment for other prognostic factors. The highest quartile of uninvolved nodes was compared with the lowest quartile. Among premenopausal patients, LRF risk was decreased by 35% (P = .0010); among postmenopausal patients, LRF risk was decreased by 46% (P < .0001). The 10-year cumulative incidence of LRF was 20% among patients with one to three involved lymph nodes and fewer than 10 uninvolved nodes. Age younger than 40 years and vessel invasion were also associated significantly with increased risk. Among patients with node-positive disease, overall survival was significantly greater in those with higher numbers of uninvolved nodes examined (P < .0001).

Conclusion Patients with one to three involved nodes and a low number of uninvolved nodes, vessel invasion, or young age have an increased risk of LRF and may be candidates for a similar treatment as those with at least four lymph node metastases.

published online ahead of print at www.jco.org on April 9, 2007.

Supported in part by Swiss Group for Clinical Cancer Research, Frontier Science and Technology Research Foundation, The Cancer Council Australia, Australian New Zealand Breast Cancer Trials Group (National Health Medical Research Council), National Cancer Institute (CA-75362), Swedish Cancer Society, Cancer Association of South Africa, and Foundation for Clinical Cancer Research of Eastern Switzerland.

Presented in part as a poster at the European Breast Cancer Conference, March 21-25, 2006, Nice, France.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?