The clinical relevance of positive sentinel nodes only versus positive nonsentinel lymph nodes in breast cancer patients

Cox, Charles; DuPont, Elisabeth L; Furman, Ben; Stowell, Nicholas; Clark, John; Ebert, Mark; Diaz, Nils M; Cantor, Alan

doi:10.1016/S0002-9610(03)00266-6

« Previous Next »The American Journal of Surgery
Volume 186, Issue 4 , Pages 333-336, October 2003

The clinical relevance of positive sentinel nodes only versus positive nonsentinel lymph nodes in breast cancer patients

Presented at the Fourth Annual Meeting of the American Society of Breast Surgeons, Atlanta, Georgia, April 30–May 4, 2003

Charles Cox, M.D.
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
- Corresponding author. Tel.: +1-813-972-8480; fax: +1-813-979-7287.
Elisabeth L DuPont, M.D.
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
Ben Furman, M.D.
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
Nicholas Stowell
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
John Clark
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
Mark Ebert
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
Nils M Diaz, M.D.
- Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr., Suite 3157, Tampa, FL 33612, USA
Alan Cantor, Ph.D.
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA

Received 3 June 2003; received in revised form 21 June 2003

Abstract

Background

The purpose of this study was to determine the difference in clinical outcomes for patients with histologically positive sentinel lymph nodes (SLN+) compared with patients with histologically positive nonsentinel second echelon lymph nodes (NSLN+).

Methods

Eight hundred thirteen node positive patients from a prospectively accrued database of 3,200 patients who underwent sentinel node mapping were evaluated. In all, 506 of the 813 patients (62%) were SLN+ only and 307 of the 813 patients (38%) were SLN+ plus at least one NSLN+. Patients' overall survival and disease-free survival were obtained and statistical analyses performed comparing the two groups.

Results

As the number of NSLN+ increased, there was a significant difference in disease-free survival (P = 0.001) and overall survival (P = 0.003) between those patients who had 0 to 4 NSLN+ and those who had 5 or more NSLN+. The SLN+ only patients did not show significant differences with respect to survival, based on the number of SLN+ (overall survival, disease-free survival; P = 0.742)

Conclusions

The survival (overall survival, disease-free survival) for patients with 3 or more SLN+ was not statistically different than for patients with 1 or 2 SLN+ (P = 0.742). However, an alteration of biologic behavior was observed when multiple NSLN+ contain metastatic breast cancer. Involvement of 5 or more NSLN+ portends a significantly (P = 0.001) worse prognosis, regardless of the number of SLN+.

Keywords: Sentinel lymph nodes, Nonsentinel lymph nodes, Outcome, Prognosis, Breast cancer, Recurrence, Lymphatic mapping