The relationship amongst stage IV triple negative breast cancer and regional lymph node métastases

Document Type

Conference Proceeding

Publication Date

3-11-2025

Publication Title

Ann Surg Oncol

Keywords

biochemical marker, adult, breast cancer, Caucasian, cohort analysis, complication, conference abstract, controlled study, diagnosis, female, human, human tissue, lymph node, lymph vessel metastasis, major clinical study, male, middle aged, primary tumor, retrospective study, surgery, triple negative breast cancer

Abstract

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 nonparametric tests, as appropriate for each variable. Statistical significance was set at p < 0.05. RESULTS: Atotal 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 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). 34 (37%) TNBC patients developed LN metastases compared to 199 (57%) ER+/PR+/HER2/neu negative patients. These patients were also 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). CONCLUSIONS: Patients with TNBC whose tumors display LVI are significantly less likely to have ALN metastases but have an increased risk of systemic metastasis. 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 subgroup.

Volume

31

First Page

S198

Last Page

S199

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