Determinants of axillary recurrence after axillary lymph node dissection for invasive breast cancer

Axillary and supraclavicular recurrences are rare after axillary lymph node dissection in breast cancer

BACKGROUND

This study was designed to evaluate the incidence of and risk factors for axillary recurrence (AR) and supraclavicular recurrence (SR) in breast cancer patients with axillary lymph node dissection.

METHODS

The study was based on 1,180 patients with unilateral invasive breast cancer operated between January 2000 and December 2003. The median duration of follow-up was 78 months.

RESULTS

The 7-year AR incidence was 0.7% and SR incidence was 1.3%. Twelve of the 14 SR patients and 4 of the 8 AR patients had concomitant distant recurrences. No risk factors for AR were identified. Histological tumor grade III as well as estrogen and progesterone negativity were risk factors for SR. SR, but not AR, was an independent risk factor for poor breast cancer-specific survival [hazard ratio, 10.116; P < 0.0001]. Among N1 patients, the extent of radiotherapy (RT) had no influence on regional recurrences. Among N2-N3 patients, the 7-year regional recurrence rates were 34.3% in patients without RT, 0% in patients with local RT, and 1.2% in patients with locoregional RT (P < 0.0001).

CONCLUSIONS

AR and SR are rare events that often are detected concomitantly with distant metastases. SRs are associated with aggressive disease and poor survival. Our results also suggest that regional RT reduces regional recurrences in N2-N3 patients but not in N1 patients, but the retrospective, nonrandomized study setting renders this conclusion as uncertain.

Predictive value of sonographic features of extranodal extension in axillary lymph nodes

OBJECTIVE

The purpose of this study was to assess the accuracy of 5 sonographic features in the prediction of extranodal extension (ENE) in axillary lymph nodes (ALNs) of patients with biopsy-proven breast cancer.

METHODS

A review of our institution's surgical and pathologic database was performed for patients with pathologically proven axillary ENE from October 1, 2003, to October 1, 2007. An equivalent number of patients without ENE were included. All patients had sonograms of ALNs available. A radiologist to whom the study was masked reviewed ALN images with specific attention to unclear margins, node matting, perinodal edema, and hilar effacement or replacement. Univariate and multivariate logistic regression analyses were used to obtain the sensitivity, specificity, and odds ratio (OR) for each feature.

RESULTS

Our review included a total of 131 patients (64 with ENE and 67 without ENE). The respective sensitivity and specificity estimates for each feature were as follows: node matting, 52% and 84%; perinodal edema, 34% and 87%; unclear margins, 64% and 75%; hilar replacement, 71% and 42%; and hilar effacement, 74% and 60%. Univariate analysis showed a statistically significant association between features and ENE with ORs as follows: matting, 5.4; perinodal edema, 3.4; unclear margins, 5.2; and hilar replacement, 4.3. Multivariate analysis showed that matting and unclear margins were independently associated with ENE.

CONCLUSIONS

The sonographic features of unclear margins, node matting, perinodal edema, and hilar replacement have a statistically significant association with ENE. The sonographic features of unclear margins, node matting, and perinodal edema predict ENE with high specificity.

Long-term prognosis of patients with axillary recurrence after axillary dissection for invasive breast cancer

AIM

To investigate the long-term prognosis of patients with axillary recurrence after axillary dissection for invasive breast cancer and describe the long-term survivors.

METHODS

Between 1984 and 1994, 4669 patients with invasive breast cancer underwent axillary dissection in eight community hospitals in the south-eastern part of The Netherlands. Using follow-up data of the population-based Eindhoven Cancer Registry, 59 patients with axillary recurrence were identified.

RESULTS

The median interval between treatment of the primary tumour and diagnosis of axillary recurrence was 2.6 years (range 0.3-10.7). The median length of follow-up after diagnosis of axillary recurrence was 11.1 years (5.7-15.6). Distant metastases occurred in 38 of the 59 patients. The 5- and 10-year distant recurrence-free survival rates were 39% (95% CI: 25-52%) and 29% (95% CI: 16-42%).

CONCLUSIONS

Axillary recurrence following axillary dissection is associated with a high rate of subsequent distant metastasis and poor overall prognosis but is not always a fatal event. Our results show that it is possible to cure about one-third of the patients.

Consequences of axillary recurrence after conservative breast surgery

BACKGROUND

The aim was to study the incidence, time course and prognosis of patients who developed axillary recurrence after breast-conserving surgery, and to evaluate possible risk factors for axillary recurrence and prognostic factors after axillary recurrence.

METHODS

In a population-based cohort of 6613 women with invasive breast cancer who had breast-conserving surgery between 1981 and 1990, 92 recurrences in the ipsilateral axilla were identified. Risk factors for axillary recurrence were studied in a case-control study nested in the cohort, and late survival was documented in the women with axillary recurrence.

RESULTS

The overall risk of axillary recurrence was 1.0 per cent at 5 years and 1.7 per cent at 10 years. The risk of axillary recurrence increased with tumour size (P = 0.033) and was highest in younger women (odds ratio (OR) 3.9 for women aged less than 40 years compared with those aged 50-59 years). Radiotherapy to the breast reduced the risk of axillary recurrence (OR 0.1 (95 per cent confidence interval 0.1 to 0.4)). The breast cancer-specific survival rate after axillary recurrence, as measured from primary treatment, was 78.0 per cent at 5 years and 52.3 per cent at 10 years. Tumour size and node status had a statistically significant effect on death from breast cancer.

CONCLUSION

Axillary recurrence is rare, although more common in younger women with large tumours. Radiotherapy to the breast was protective. Tumour size and node status were the most important prognostic factors in women with axillary recurrence.