Prognostic value of isolated tumour cells in sentinel lymph nodes in early-stage breast cancer: a prospective study
Menée auprès de 936 patientes atteintes d'un cancer du sein unilatéral de stade précoce traité entre 2001 et 2005 (durée médiane de suivi : 9,5 ans), cette étude évalue l'association entre la présence de cellules tumorales isolées dans les ganglions sentinelles et le pronostic
Background : The prognostic significance of isolated tumour cells (ITCs) in the sentinel nodes (SNs) is controversial in early breast cancer, and some centres have abandoned immunohistochemistry to detect ITCs.
Methods : Patients with unilateral pT1N0 breast cancer, operated between February 2001 and August 2005 at a university hospital were included in this prospective, population-based cohort study. Survival of 936 patients with or without isolated tumour cells (ITC) in their SNs were compared with the log-rank test and Cox regression analysis.
Results : Eight hundred sixty one (92.0%) patients were ITC-negative (pN0i−) and 75 (8.0%) ITC-positive (pN0i+). Patients with ITC-positive cancer received more frequently adjuvant systemic therapies than those with ITC-negative cancer. The median follow-up time was 9.5 years. Ten-year distant disease-free survival was 95.3% in the pN0i− group and 88.8% in the pN0i+ group (P = 0.013). ITCs were an independent prognostic factor in a Cox regression model (HR = 2.34, 95% CI 1.09–5.04; P = 0.029), together with tumour Ki-67 proliferation index and diameter. ITCs were associated with unfavourable overall survival (P = 0.005) and breast cancer-specific survival (P = 0.001).
Conclusions : We conclude that presence of ITCs in the SNs is an adverse prognostic factor in early small node-negative breast cancer, and may be considered in the decision-making for adjuvant therapy.
British Journal of Cancer , résumé, 2018