Distant Lymph Node Metastases From Breast Cancer: A Regional Disease?
Posted: Thursday, April 29, 2021
Wenbin Zhou, MD, PhD, of Nanjing Medical University, China, and colleagues investigated survival differences in patients with stage IV breast cancer who had different types of lymph node metastases. Published in JAMA Network Open, their findings demonstrated a similar safety profile for both distant lymph node metastases (DLNM) and ipsilateral supraclavicular lymph node metastases (ISLM). These results suggest that DLNM from breast cancer may be a regional disease, potentially benefiting from locoregional therapies.
Reassessment of the role of lymph node metastases in breast cancer was supported by an accompanying commentary by Yutian Zou, MD, of Sun Yat-sen University Cancer Center, Guangzhou, China, and colleagues. “Owing to the fact that lymph node metastases of several sites are now redefined as locoregional instead of distant disease, is it necessary to reconsider DLNM as a local disease as well? Fortuitously, this cohort study provides critical evidence.”
From the Surveillance, Epidemiology, and End Results registries database, this trial enrolled 2,033 patients with breast cancer who either had ISLM without any distant metastasis, DLNM, or distant metastasis with DLNM excluded. Treatment regimens were obtained from records of patients with DLNM.
Of the total participants, 10.4% had ISLM, 17.0% had DLNM, and 72.6% had distant metastases. The breast cancer–specific survival rates at 3 years for distant metastases, ISLM, and DLNM, were 41.20%, 63.24%, and 64.54%, respectively; overall survival rates were 38.21%, 53.46%, and 62.67%, respectively. Individuals with ISLM and DLNM demonstrated similar breast cancer–specific survival (hazard ratio [HR] = 0.81) and overall survival (HR = 0.73), whereas significantly poorer survival rates (HR = 1.99 for breast cancer–specific and 1.79 for overall survival) were observed in individuals with distant metastases.
Of 346 patients with DLNM, 52 underwent distant lymph node surgery, 127 received radiotherapy, and 193 had surgery on the primary tumor. A significant association with improved overall survival was reported with primary surgery (HR = 0.21) and radiotherapy (HR = 0.46).
Disclosure: The study authors reported no conflicts of interest.