Histopathologic evidence of tumor regression in the axillary lymph nodes of patients treated with preoperative chemotherapy correlates with breast cancer outcome

The benefits of primary tumor downstaging and assessment of chemoresponsiveness have resulted in expanded applications for induction chemotherapy. However, the pathologic evaluation and prognostic significance of response in preoperatively treated lymph nodes have not been defined. The axillary lymp...

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Published in:	Annals of surgical oncology Vol. 10; no. 7; pp. 734 - 739
Main Authors:	Newman, Lisa A, Pernick, Nat L, Adsay, Volkan, Carolin, Kathryn A, Philip, Philip A, Sipierski, Susan, Bouwman, David L, Kosir, Mary A, White, Michael, Visscher, Daniel W, Philip, Philip I
Format:	Journal Article
Language:	English
Published:	United States Springer Nature B.V 01-08-2003
Subjects:	Breast Neoplasms - drug therapy Breast Neoplasms - mortality Breast Neoplasms - pathology Carcinoma, Ductal, Breast - drug therapy Carcinoma, Ductal, Breast - mortality Carcinoma, Ductal, Breast - pathology Female Fibrosis Humans Lymph Nodes - pathology Lymphatic Metastasis Middle Aged Prognosis Remission Induction Treatment Outcome
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Summary:	The benefits of primary tumor downstaging and assessment of chemoresponsiveness have resulted in expanded applications for induction chemotherapy. However, the pathologic evaluation and prognostic significance of response in preoperatively treated lymph nodes have not been defined. The axillary lymph nodes of 71 patients with locally advanced breast cancer treated with induction chemotherapy were evaluated for histological evidence of tumor regression as defined by the presence of nodal fibrosis, mucin pools, or aggregates of foamy histiocytes. Complete pathologic response in the breast and axilla occurred in 10 patients (14%); 19 (26.8%) had evidence of tumor regression in 1 or more lymph nodes. Patients without nodal metastases and no evidence of tumor regression had the best outcome (median disease-free survival, 31.5 months; relapse rate, 27%). Patients with residual nodal metastases and no evidence of treatment effect had the worst outcome (median disease-free survival, 19.8 months; relapse rate, 55%). The median disease-free survival was 22.1 months, and the relapse rate was 32% for patients with histopathologic evidence of tumor regression in the axillary lymph nodes. Detection of treatment effect in axillary lymph nodes after induction chemotherapy identifies a subset of patients with an outcome intermediate between that of completely node-negative and node-positive patients. The axillary lymph nodes of patients receiving preoperative chemotherapy should be routinely analyzed for the presence of these features.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/ASO.2003.03.081