The Relationship Among Stage IV Triple Negative Breast Cancer and Regional Lymph Node Metastases
Recommended Citation
Bui J, Nathanson S, Bensenhaver J, Schwartz T, Petersen L, Lehrberg A, Dalla Vecchia L, Springer K, Susick L. The Relationship Among Stage IV Triple Negative Breast Cancer and Regional Lymph Node Metastases. Ann Surg Oncol 2025; 32:787.
Document Type
Conference Proceeding
Publication Date
7-8-2025
Publication Title
Ann Surg Oncol
Keywords
Oncology, Surgery
Abstract
Background/Objective: Clinical, pathological, and genetic evidence indicates that breast cancer (BC) typically invades peri-tumoral vessels, spreading first to regional lymph nodes (LNs) before metastasizing to systemic sites. However, some patients develop systemic metastases without LN involvement. Observing a trend of fewer LN metastases in triple-negative breast cancer (TNBC) patients, we hypothesized that Stage IV TNBC may represent a subtype in which the pathway to systemic metastasis bypasses the LNs entirely. Methods: We examined all TNBC and ER+/PR+/HER2/neu negative BC patients with lymphovascular invasion (LVI) within our vertically integrated healthcare system. Data were drawn from a long-term, prospectively maintained database from 1995–2022. Patients excluded from the study included men, BC recurrences, and instances of missing pathological or molecular information. All clinicopathologic and molecular categorical data, including histologically confirmed ALN and systematic metastases, were analyzed statistically using both parametric and non-parametric tests, as appropriate for each variable. Statistical significance was set at p < 0.05. Results: A total of 446 patients with LVI: 91 (20%) TNBC and 355 (80%) ER+/PR+/HER2/neu negative were compared. The median age (interquartile range) of the study cohort was 60 (51-70). Patients were predominantly white (228, 59%). 19 (21%) of TNBC patients developed systemic metastases compared to 37 (10%) of ER+/PR+/HER2/neu negative patients (p=0.003). Patients with TNBC and LVI were more likely to have systemic metastasis compared to the ER+/PR+/HER2/neu negative patients with LVI (OR: 3.730, 95% CI: 1.545-9.006, p=0.003). 34 (37%) TNBC patients developed LN metastases compared to 199 (57%) ER+/PR+/HER2/neu negative patients (p=0.001). These TNBC patients were less likely to have LN metastasis than ER+/PR+/HER2/neu negative patients with LVI (OR: 0.456, 95% CI: 0.284-0.73, p=0.001). Conclusions: Patients with TNBC whose tumors display LVI are significantly less likely to have ALN metastases but have an increased risk of systemic metastasis, which is consistent with existing literature that suggests that TNBC has a higher propensity for early distant spread, even in the absence of regional nodal involvement. If we could identify molecular, genetic, or biochemical markers in primary tumors that predict which patients are more prone to systemic metastasis without LN involvement, we could potentially avoid sentinel LN biopsy in this subgr
Volume
32
First Page
787
