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Size of Residual Lymph Node Metastasis After Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients Is Prognostic

¹ Department of Surgery, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB #7213, Chapel Hill, North Carolina 27599
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 102 Mason Farm Road, CB #7295, Chapel Hill, North Carolina 27599
³ Department of Biostatistics, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7420, Chapel Hill, North Carolina 27599
⁴ Department of Pathology and Lab Medicine, University of North Carolina at Chapel Hill, 30145 Women and Children’s Hospital, CB #7525, Chapel Hill, North Carolina 27599
⁵ Department of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, CB #7305, Chapel Hill, North Carolina 27599
⁶ Department of Radiation Oncology, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7512, Chapel Hill, North Carolina 27599

Correspondence: Address correspondence and reprint requests to: Nancy Klauber-DeMore, MD; E-mail: nancy_demore{at}med.unc.edu.

Background: The prognostic significance of micrometastasis after neoadjuvant chemotherapy for locally advanced breast cancer is unknown. We examined the residual lymph node metastasis size in patients after treatment with neoadjuvant chemotherapy to determine the relevance of metastasis size on outcome.

Methods: Stage II/III breast cancer patients treated with neoadjuvant chemotherapy at our institution from 1991 to 2002 were included. We examined the relationship of postneoadjuvant chemotherapy lymph node metastasis size and number with distant disease-free survival (DDFS) and overall survival (OS).

Results: In 122 patients with a median follow-up of 5.4 years, we found not only that patients with an increasing number of residual positive nodes had progressively worse DDFS and OS (P < .0001 for both) compared with patients with negative nodes, but also that the size of the largest lymph node metastasis was associated with worse DDFS and OS (P < .0001 for both) in both univariate and multivariate analysis. Compared with negative nodes, even lymph node micrometastasis (<2 mm) was associated with worsened DDFS and OS (adjusted P = .02 and P = .005, respectively).

Conclusions: Residual micrometastatic disease in the axillary lymph nodes after neoadjuvant chemotherapy is predictive of worse prognosis than negative nodes. In this study, the lymph node metastasis size and the number of involved lymph nodes were independent powerful predictors of DDFS and OS.

Key Words: Micrometastasis • Breast cancer • Neoadjuvant therapy • Lymph node metastasis • Tumor dormancy

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