Originally published as JCO Early Release 10.1200/JCO.2008.16.7619 on May 18 2009

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Relationship Between Age and Axillary Lymph Node Involvement in Women With Breast Cancer

Hans Wildiers, Ben Van Calster, Lonneke V. van de Poll-Franse, Wouter Hendrickx, Jo Røislien, Ann Smeets, Robert Paridaens, Karen Deraedt, Karin Leunen, Caroline Weltens, Sabine Van Huffel, Marie-Rose Christiaens, Patrick Neven

From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway.

Corresponding author: Hans Wildiers, MD, PhD, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium; e-mail: hans.wildiers{at}uz.kuleuven.ac.be.

Purpose To study the relation between the presence of axillary lymph node (LN) involvement and age in breast cancer.

Patients and Methods The breast cancer database of the University Hospitals Leuven contains complete data on 2,227 patients with early breast cancer consecutively treated between 2000 and 2005. A multivariate piecewise logistic regression model was used to analyze LN involvement in relation to age at diagnosis. A similar analysis was then performed on a large, independent, population-based database from the Eindhoven Cancer Registry to investigate whether the effects of the Leuven model could be replicated.

Results We observed a piecewise effect of age. That is, women up to 70 years of age were less likely to have positive LNs with increasing age (odds ratio per 10-year increase, 0.87). In contrast, older women were more likely to have positive LNs with increasing age. However, for older women, the effect of age interacted with tumor size (P = .0044), suggesting that increasing age is associated with increased risk of LN involvement, mainly in small tumors. These findings were replicated in the Eindhoven Cancer Registry database.

Conclusion Axillary LN involvement varies with age at diagnosis; its probability decreases with increasing age up to the age of approximately 70 years, but increases again thereafter. However, this increase is mainly seen in smaller tumors and suggests a different behavior of small breast cancers in older adult patients. We hypothesize that decreased immune defense mechanisms, related with aging, may play a role in earlier invasion into LNs.

H.W. and B.V.C both contributed equally to this work.

Supported by Katholieke Universiteit Leuven research council Grant No. GOA-AMBioRICS and European Union projects BIOPATTERN (Grant No. FP6-2002-IST 508803), ETUMOR (Grant No. FP6-2002-LIFESCIHEALTH 503094), and Healthagents (Grant No. IST–2004-27214). B.V.C. is a postdoctoral researcher funded by the Research Foundation–Flanders (FWO).

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

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