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What Is High-Risk Breast Cancer with Pathologically Negative Lymph Nodes for Regional Recurrence?

Sang-Won Kim,W. Cho,D. Choi,Haeyoung Kim,O. Cho,W. Park,M. Chun

Published 2021 in International Journal of Radiation Oncology, Biology, Physics

ABSTRACT

PURPOSE This study aimed to identify high-risk factors for regional recurrence in breast cancer patients with pathologically negative lymph nodes. METHODS AND MATERIALS We retrospectively analyzed 3,800 breast cancer patients with pT1-3 stage and pathologically negative lymph nodes between 2004 and 2012. All patients underwent upfront surgery with curative intent. Adjuvant systemic treatments were administered to most patients (96.7%), based on contemporary guidelines. RESULTS After a median follow-up of 83 months (range, 7-175 months), the estimated 10-year cumulative incidence rate of regional recurrence was 2.0%. Multivariate competing risk analysis revealed that high histologic grade, positive lymphovascular invasion, and pT2-3 stage were significant risk factors for any regional recurrence. Patients with ≥2 risk factors showed a significantly higher 10-year cumulative incidence rate of any regional recurrence than those with 0-1 risk factor (5.5 % vs. 1.2%, p <0.001). When the number of retrieved lymph nodes was less than 10, the difference in the incidence rate of regional recurrence between patients with ≥2 risk factors and those with 0-1 risk factors was greater (6.6% vs. 1.3%, respectively, p <0.001). The 10-year disease-free survival was worse in patients with ≥2 risk factors than in those with 0-1 risk factors (84.7% vs. 90.0%, respectively; p <0.001). Patients with ≥2 risk factors also showed worse 10-year overall survival than those with 0-1 risk factors (91.3% vs. 97.0%, respectively; p <0.001). CONCLUSION Overall, the cumulative incidence rate of any regional recurrence was low at 10 years. However, patients with ≥2 risk factors showed an increased risk of any regional recurrence and worse disease-free survival, particularly when the number of retrieved lymph nodes was less than 10.

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