Dataset Information

Lymph node status have a prognostic impact in breast cancer patients with distant metastasis.

ABSTRACT:

Background

The objective of this retrospective study was to determine whether lymph node metastasis has a prognostic impact on patients with stage IV breast cancer.

Patients and methods

Seven thousand three hundred and seventy-nine patients with de novo stage IV breast cancer diagnosed from 2004 to 2013 were identified. Kaplan-Meier estimate method was fitted to measure overall survival and breast cancer-specific survival (BCSS). Cox proportional hazard analysis was used to evaluate the association between N stage and BCSS after controlling variables such as other patient/tumor characteristics.

Results

The primary site of M1 tumors was mainly upper-outer quadrant and overlapping lesion of the breast. Patients with N1 disease had better overall survival and BCSS than did those without lymph node metastasis. The overall survival and BCSS of M1 patients with N3 disease were significantly lower than that of those with N0, N1 and N2 disease, whereas patients with N2 and N0/N1 involvement showed no significant difference with survival. Multivariate analysis showed that lymph node metastasis was an important prognostic factor for M1 patients (N1 versus N0, hazard ratio [HR] = 0.902, 95% confidence interval [CI]: 0.825-0.986, p = 0.023; N3 versus N0, HR = 1.161, 95% CI: 1.055-1.276, p = 0.002). For M1 patients, age, race, marital status, primary site, ER, PR and HER2 were the independent prognostic factors.

Conclusions

The cohort study provides an insight into de novo stage IV breast cancer with lymph node metastasis. Our results indicated that accurate lymph node evaluation for stage IV patients is still necessary to obtain important prognostic information.

SUBMITTER: Tang C

PROVIDER: S-EPMC5555564 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Lymph node status have a prognostic impact in breast cancer patients with distant metastasis.

Tang Chuangang C Wang Pei P Li Xiaoxin X Zhao Bingqing B Yang Haochang H Yu Haifeng H Li Changwen C

PloS one 20170814 8

<h4>Background</h4>The objective of this retrospective study was to determine whether lymph node metastasis has a prognostic impact on patients with stage IV breast cancer.<h4>Patients and methods</h4>Seven thousand three hundred and seventy-nine patients with de novo stage IV breast cancer diagnosed from 2004 to 2013 were identified. Kaplan-Meier estimate method was fitted to measure overall survival and breast cancer-specific survival (BCSS). Cox proportional hazard analysis was used to evalua ...[more]

PMID: 28806399

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Project description:BackgroundThe prognosis of lymph node-negative triple-negative breast cancer (TNBC) is still worse than that of other subtypes despite adjuvant chemotherapy. Reliable prognostic biomarkers are required to identify lymph node-negative TNBC patients at a high risk of distant metastasis and optimize individual treatment.MethodsWe analyzed the RNA sequencing data of primary tumor tissue and the clinicopathological data of 202 lymph node-negative TNBC patients. The cohort was randomly divided into training and validation sets. Least absolute shrinkage and selection operator Cox regression and multivariate Cox regression were used to construct the prognostic model.ResultsA clinical prognostic model, seven-gene signature, and combined model were constructed using the training set and validated using the validation set. The seven-gene signature was established based on the genomic variables associated with distant metastasis after shrinkage correction. The difference in the risk of distant metastasis between the low- and high-risk groups was statistically significant using the seven-gene signature (training set: P < 0.001; validation set: P = 0.039). The combined model showed significance in the training set (P < 0.001) and trended toward significance in the validation set (P = 0.071). The seven-gene signature showed improved prognostic accuracy relative to the clinical signature in the training data (AUC value of 4-year ROC, 0.879 vs. 0.699, P = 0.046). Moreover, the composite clinical and gene signature also showed improved prognostic accuracy relative to the clinical signature (AUC value of 4-year ROC: 0.888 vs. 0.699, P = 0.029; AUC value of 5-year ROC: 0.882 vs. 0.693, P = 0.038). A nomogram model was constructed with the seven-gene signature, patient age, and tumor size.ConclusionsThe proposed signature may improve the risk stratification of lymph node-negative TNBC patients. High-risk lymph node-negative TNBC patients may benefit from treatment escalation.

Project description:The prognostic importance of lymph node (LN) status and tumour-infiltrating lymphocytes (TILs), is well established, particularly TILs in triple negative breast cancers (TNBCs). So far, few studies have interrogated changes in involved and uninvolved LNs and evaluated if their morphological patterns add valuable information for the prediction of disease progression in breast cancer. In a cohort of 309 patients enriched for TNBCs (170/309), we histologically characterised immune and stromal features in primary tumours and associated involved and uninvolved axillary LNs on routine haematoxylin and eosin stained sections. Of the 309 patients, 143 had LN-positive disease. Twenty-five histopathological features were assessed, including the degree of TIL presence, quantitative and qualitative assessment of germinal centres (GCs) and sinus histiocytosis. Multivariate and cross-validated proportional hazard regression analyses were used to identify optimal covariate sets for prediction of distant metastasis-free survival (DMFS). The degree of intratumoural and peritumoural immune infiltrate was associated with architectural changes in both uninvolved and involved LNs. By including clinicopathological characteristics as well as tumour and LN histopathological features in L2-regularised proportional hazard models, the prediction of 5-year DMFS was improved by 3-15% over the baseline in all cancers and in TNBCs. In LN-positive cancers, the combination of Salgado's classification, lymphocytic lobulitis, size and number of GCs in the uninvolved LNs and location of GCs in the involved LNs carried significant prognostic information. From these features, a multivariate cross-validation-stable risk signature was constructed, which identified low-risk groups within both LN-positive breast cancers and the LN-positive TNBCs group with a 10-year DMFS probability of 78 and 87%, respectively. This study illustrates that, by incorporating histopathological patterns of involved and uninvolved LNs combined with primary tumour immune and stromal features, the prediction of developing distant metastasis in LN-positive breast cancers can be estimated more accurately.

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Dataset Information

Lymph node status have a prognostic impact in breast cancer patients with distant metastasis.

Background

Patients and methods

Results

Conclusions

Publications

Lymph node status have a prognostic impact in breast cancer patients with distant metastasis.

Similar Datasets

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