Positive axillary lymph node metastases in T1–T3 breast cancer: prognostic value of extracapsular extension

Background

Extracapsular extension (ECE) of axillary metastases has importance as a risk factor for local or distant recurrence. Poorer survival in breast cancer has been suggested, but its prognostic value has not been uniformly confirmed.

Methods

From January 2000 to March 2007, 356 breast cancer patients were operated on in the Department of General Surgery of General Hospital 'Sveti Vracevi' in Bijeljina. We selected 173 (48.6%) cases with pT1–pT3 node-positive breast cancer. The prognostic significance of ECE of axillary metastases was evaluated with respect to disease-free survival, overall survival, and the patterns of disease recurrence. Such prognostic significance was then compared with that of other clinical and pathologic factors.

Results

Ninety-five patients (26.68%) presented with ECE. Thirty patients (31.57%) were identified as having three or less lymph nodes involved, 26 patients (27.36%) patients four to six nodes, 18 patients (18.9%) seven to nine nodes, and 22.16% patients 10 or more nodes, respectively. With a median follow-up of 86 months, factors with independent prognostic value for disease-free survival by multivariate analysis included absence of estrogen receptors (P < 0.005), pN category (P < 0.01), presence of lymphovascular invasion (LVI; P < 0.005), and ECE (P < 0.001). An independent negative prognostic effect on overall survival was observed for absence of estrogen and progesterone receptors (P < 0.05), pN category (P < 0.05), and presence of LVI (P < 0.005) and ECE (P < 0.001).

Conclusion

ECE demonstrated a stronger statistical significance in predicting prognosis than the pN category and was also related to an increased risk of distant recurrences. We suggest that the decision on adjuvant therapy should consider the presence of ECE of axillary metastases and peritumoral LVI as indicators of high biological aggressiveness. Balancing the risks and benefits of irradiation, we continue to recommend that complete axillary irradiation is not routinely indicated after adequate axillary dissection.