DOI QR코드

DOI QR Code

Lymph Node Ratio Assessment of Brain Metastasis in Early Breast Cancer Cases

  • Demircioglu, Fatih (Department of Radiation Oncology, Rize Recep Tayyip Erdogan University Hospital) ;
  • Demirci, Umut (Department of Medical Oncology, Ataturk Training and Research Hospital) ;
  • Akmansu, Muge (Department of Radiation Oncology, Gazi University Faculty of Medicine)
  • Published : 2013.03.30

Abstract

Background: Ten to 30% of early breast cancer (EBC) patients develop brain metastasis (BM) during their follow-up. In this study, we aimed to evaluate importance of the lymph node ratio (LNR) in development of BM in EBC cases. Materials and Methods: Ninety patients whom had axillary metastases in lymph nodes at their initial diagnosis and developed BM during 5-year follow-up were detected in 950 EBC patients. LNR values were calculated for all patients and after categorization into 4 molecular sub-types as luminal A, luminal B HER-2 (+), HER-2 overexpressing and basal- like. Comparison was with control group patients who had similar characteristics. Results: In the comparison of all molecular sub-types of LNR, 54.9% and 28.4% values were found in patients with and without BM respectively (p<0.001). In the comparison of the LNR with control groups, a statistically significant differences were found with luminal A with BM (p=0.001), luminal B HER-2 (p=0.001), HER-2 overexpressing (p=0.027) and basal-like groups (p<0.001). In the evaluation of patients with BM, the highest ratio was found in the basal-like group (67.9%) and there was a statistically significant difference between this group and the others (p=0.048). Conclusions: EBC patients developing BM within 5 years follow-up had significantly higher LNRs for all molecular sub-types, especially in the basal-like group. Larger scale studies are now needed for evaluating LNR prognostic importance for EBC regarding BM development.

References

  1. Alanko A, Heinonen E, Scheinin T, et al (1985). Significance of estrogen and progesterone receptors, disease-free interval, and site of first metastasis on survival of breast cancer patients. Cancer, 56, 1696-700. https://doi.org/10.1002/1097-0142(19851001)56:7<1696::AID-CNCR2820560738>3.0.CO;2-N
  2. Barnholtz-Sloan JS, Sloan AE, Davis FG, et al (2004). Incidence proportions of brain metastases in patients diagnosed (1973e2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol, 22, 2865-72. https://doi.org/10.1200/JCO.2004.12.149
  3. Chia S, Norris B, Speers C, et al (2008). Human epidermal growth factor receptor 2 overexpression as a prognostic factor in a large tissue microarray series of node-negative breast cancers. J Clin Oncol, 26, 5697-704. https://doi.org/10.1200/JCO.2007.15.8659
  4. Dayan A, Koca D, Akman T, et al (2012). The factors that have an impact on the development of brain metastasis in the patients with breast cancer. J Cancer Res Ther, 8, 542-8. https://doi.org/10.4103/0973-1482.106531
  5. Engel J, Eckel R, Aydemir U (2003). Determinants and prognoses of locoregional and distant progression in breast cancer. Int J Radiat Oncol Biol Phys, 55, 1186-95. https://doi.org/10.1016/S0360-3016(02)04476-0
  6. Goldhirsc A, Wood WC, Coates AS, et al (2011). Strategies for subtypes-dealing with the diversity of breast cancer:highlights of the St. gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol, 22, 1736-47. https://doi.org/10.1093/annonc/mdr304
  7. Gong Y, Han EY, Guo M, Pusztai L, Sneige L (2011). Stability of estrogen receptor status in breast carcinoma: a comparison between primary and metastatic tumors with regard to disease course and intervening systemic therapy. Cancer, 117, 705-13. https://doi.org/10.1002/cncr.25506
  8. Greene FL, Page DL, Fleming ID, et al (2002). American joint committee on cancer. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag.
  9. Hatoum HA, Jamali FR, El-Saghir NS, et al (2009). Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph node-positive breast cancer. Ann Surg Oncol, 16, 3388-95. https://doi.org/10.1245/s10434-009-0653-8
  10. Hoefnagel LD, van de Vijver MJ, van Slooten HJ, et al (2010). Receptor conversion in distant breast cancer metastases. Breast Cancer Res, 12, 75. https://doi.org/10.1186/bcr2645
  11. Karlsson E, Lindstrom LS, Wilking U, Skoog L, Johansson U (2010). Discordance in hormone receptor status in breast cancer during tumor progression. J Clin Oncol, 28, 1009.
  12. Kennecke H, Yerushalmi R, Woods R, et al (2010). Metastatic Behavior of Breast Cancer Subtypes. J Clin Oncol, 28, 3271-7. https://doi.org/10.1200/JCO.2009.25.9820
  13. Li Y, Holmes E, Shah K, et al (2012). The prognostic value of lymph node cross-sectional cancer area in node-positive breast cancer: a comparison with N stage and lymph node ratio. Patholog Res Int, 2012, 161964.
  14. Lin NU, Bellon JR, Winer EP (2004). CNS metastases in breast cancer. J Clin Oncol, 22, 3608-17. https://doi.org/10.1200/JCO.2004.01.175
  15. Vinh-Hung V, Nguyen NP, Cserni G, et al (2009). Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol, 5, 1585-603. https://doi.org/10.2217/fon.09.129
  16. Vinh-Hung V, Verkooijen HM, Fioretta G, et al (2009). Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol, 27, 1062-8. https://doi.org/10.1200/JCO.2008.18.6965
  17. Woodward WA, Vinh-Hung V, Ueno NT, et al (2006). Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol, 24, 2910-6. https://doi.org/10.1200/JCO.2005.03.1526
  18. Ziaei JE, Pourzand A, Bayat A, Vaez J (2012). Patterns of metastasis and survival in breast cancer patients: a preliminary study in an Iranian population. Asian Pac J Cancer Prev, 13, 937-40. https://doi.org/10.7314/APJCP.2012.13.3.937

Cited by

  1. Role of HER2 in Brain Metastasis of Breast Cancer: a Systematic Review and Meta-Analysis vol.16, pp.4, 2015, https://doi.org/10.7314/APJCP.2015.16.4.1431
  2. A New Tool to Predict Survival after Radiosurgery Alone for Newly Diagnosed Cerebral Metastases vol.16, pp.7, 2015, https://doi.org/10.7314/APJCP.2015.16.7.2967