scholarly journals Staging for Breast Cancer With Internal Mammary Lymph Nodes Metastasis: Utility of Incorporating Biologic Factors

2021 ◽  
Vol 10 ◽  
Author(s):  
Chen-Lu Lian ◽  
Hai-Yan Zhang ◽  
Jun Wang ◽  
Jian Lei ◽  
Li Hua ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Staging System ◽  
Disease Stage ◽  
Rank Test ◽  
Breast Cancer Patients ◽  
Internal Mammary Lymph Nodes ◽  
Internal Mammary ◽  
Prognostic Staging System

PurposeTo validate the 8th edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging system for breast cancer patients with internal mammary lymph nodes (IMN) metastasis (N3b disease, stage IIIC in 7th AJCC anatomical staging).MethodsBreast cancer patients with IMN metastasis diagnosed between 2010 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Log-rank test, Kaplan-Meier method, and Cox proportional hazard analysis were applied to statistical analysis.ResultsWe included 678 patients with N3b disease in this study. Overall, 68.4% of patients were downstaged to IIIA and IIIB diseases from the 7th anatomical staging to 8th pathological prognostic staging. The new pathological prognostic staging system had better discriminatory value on prognosis prediction among IMN-metastasized breast cancer patients, with a 5-year breast cancer-specific survival (BCSS) of 92.7, 77.4, and 66.0% in stage IIIA, IIIB, and IIIC diseases, respectively (P<0.0001), and the 5-year overall survival (OS) rates was 85.9, 72.1, and 58.7%, respectively (P<0.0001). The results of the multivariate prognostic analysis showed that the new pathological prognostic staging was the independent prognosis related to BCSS and OS, the 8th AJCC pathological prognostic stages showed worse BCSS and OS with gradually increased hazard ratios.ConclusionThe 8th AJCC pathological prognostic staging system offers more refined prognostic stratification to IMN-metastasized breast cancer patients and endorses its use in routine clinical practice for this specific subgroup of breast cancer.

scholarly journals Can internal mammary lymph nodes irradiation bring survival benefits for breast cancer patients? A systematic review and meta-analysis of 12,705 patients in 12 studies

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sicong Jia ◽  
Zhikun Liu ◽  
Jun Zhang ◽  
Chenguang Zhao ◽  
Longyu Zhu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Breast Cancer Patients ◽  
Risk Of Death ◽  
Internal Mammary Lymph Nodes ◽  
Medical Network ◽  
Internal Mammary

Abstract Objective To evaluate the effect of prophylactic irradiation of internal mammary lymph nodes in breast cancer patients. Methods The computer searched PubMed, EMBASE, Web of science, CNKI, Wanfang Medical Network, the Chinese Biomedical Literature Database to find clinical studies on internal mammary lymph node irradiation (IMNI) in breast cancer. The quality of the included literature was evaluated according to the Newcastle–Ottawa scale. Stata14 software was used for meta-analysis. Results A total of 12,705 patients in 12 articles were included for meta-analyzed. Compared with patients who unirradiated internal mammary lymph nodes (non-IMNI), the risk of death for patients after IMNI was reduced by 11% (HR 0.89, 95% CI 0.79–1.00, P = 0.0470); DFS of group mixed N+ patients (high risk group) was significantly improved after IMNI (HR 0.58, 95% CI 0.49–0.69, P < 0.001). Further subgroup analysis shows that compared with non-IMNI, DFS was significantly increased in N1or ypN1 subgroup (HR 0.65, 95% CI 0.49–0.87, P = 0.003) and N2or ypN2 subgroup (HR 0.51, 95% CI 0.37–0.70, P < 0.001) after IMNI, but there was no statistical difference in DFS between the IMNI and non-IMNI groups in N0 subgroup (HR 1.02 95% CI 0.87–1.20, P = 0.794) and N3 or ypN3 subgroup (HR 0.85, 95% CI 0.49–1.45, P = 0.547). No serious incidents were reported in all the included studies, and most of the acute and late side effects were mild and tolerable. Conclusion Under modern radiotherapy techniques, IMNI can safely and effectively bring clinical benefits to N1–2 breast cancer patients, but its role in N0, N3 breast cancer patients remains to be further studied.

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