Abstract
Objective
To examine the relationship between large tumor size and breast cancer–specific mortality
(BCSM), especially in a subset of patients with negative lymph nodes (LNs).
Patients and Methods
We used the Surveillance, Epidemiology and End Results registry to identify 107,705
female patients diagnosed from January 1, 1990, through December 31, 2003, as having
invasive breast cancer and treated with surgery and LN dissection. Relevant issues
unclear in the database were studied in an additional 335 patients with locally advanced
disease treated with neoadjuvant chemotherapy.
Results
In the multivariable analysis, a significant interaction was found between tumor size
and LN involvement (P<.001). In LN-negative diseases, the relationship between tumor size and BCSM was
piecewise. Using 21- to 30-mm tumors as the reference, the hazard ratio (HR) of BCSM
increased with increasing tumor size until a peak at 41 to 50 mm (HR, 1.49; P<.001), after which increasing tumor size was unexpectedly related to decreasing hazard,
with a nadir at 61 to 80 mm (HR, 1.06; P=.70). The 61- to 80-mm tumors exhibited a significantly lower BCSM compared with
the 41- to 50-mm (P=.02) and greater than 80-mm (P=.03) subgroups. This pattern remained after stratification by estrogen receptor status
but was not observed in patients with LN-positive disease. Further analysis indicated
that the survival advantage of 61- to 80-mm tumors in LN-negative disease might result
from its low risk of distant metastasis.
Conclusion
A relatively larger tumor size without LN involvement may be a surrogate for biologically
indolent disease of distant metastasis. Our findings, if validated in other large
databases, may provide better understanding of breast cancer biology.
Abbreviations and Acronyms:
AJCC (American Joint Committee on Cancer), BCSM (breast cancer–specific mortality), DRFS (distant relapse-free survival), ER (estrogen receptor), FDSCC (Fudan University Shanghai Cancer Center), HR (hazard ratio), LN (lymph node), NCT (neoadjuvant chemotherapy), pCR (pathological complete remission), PR (progesterone receptor), RFS (relapse-free survival), SEER (Surveillance, Epidemiology and End Results)To read this article in full you will need to make a payment
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References
- Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005.Ann Oncol. 2005; 16: 1569-1583
- Revision of the American Joint Committee on Cancer staging system for breast cancer.J Clin Oncol. 2002; 20: 3628-3636
- Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.Cancer. 1989; 63: 181-187
- Ten-year outcomes in a population-based cohort of node-negative, lymphatic, and vascular invasion-negative early breast cancers without adjuvant systemic therapies.J Clin Oncol. 2004; 22: 1630-1637
- Systemic spread is an early step in breast cancer.Cancer Cell. 2008; 13: 58-68
- Effect of very small tumor size on cancer-specific mortality in node-positive breast cancer.J Clin Oncol. 2011; 29: 2619-2627
- The Surveillance, Epidemiology, and End Results program: a national resource.Cancer Epidemiol Biomarkers Prev. 1999; 8: 1117-1121
- A prognostic model to predict outcome of patients failing to achieve pathological complete response after anthracycline-containing neoadjuvant chemotherapy for breast cancer.J Surg Oncol. 2012; 105: 577-585
- Is cancer a disease of self-seeding?.Nat Med. 2006; 12: 875-878
- From latent disseminated cells to overt metastasis: genetic analysis of systemic breast cancer progression.Proc Natl Acad Sci U S A. 2003; 100: 7737-7742
- Clinical and pathological characteristics of occult breast cancer and review of the literature.J BUON. 2011; 16: 434-436
- Breast cancer tumor size, nodal status, and prognosis: biology trumps anatomy.J Clin Oncol. 2011; 29: 2610-2612
- Cancer statistics, 2010.CA Cancer J Clin. 2010; 60: 277-300
- An estrogen receptor-negative breast cancer subset characterized by a hormonally regulated transcriptional program and response to androgen.Oncogene. 2006; 25: 3994-4008
Article Info
Footnotes
Grant Support: This research was supported by grants 30971143 , 30972936 , and 81001169 from the National Natural Science Foundation of China , grant SHDC12010116 from the Shanghai United Developing Technology Project of Municipal Hospitals , the Key Clinical Program of the Ministry of Health (2010-2012), the Zhuo-Xue Project of Fudan University (K.-D.Y.), and grant 11QA1401400 from the Shanghai Committee of Science and Technology Fund for the 2011 Qimingxing Project (K.-D.Y.).
Role of the Sponsors: The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
