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. 2017 Mar;143(3):467-474.
doi: 10.1007/s00432-016-2295-0. Epub 2016 Nov 3.

Therapeutic role of axillary lymph node dissection in patients with stage IV breast cancer: a population-based analysis

San-Gang Wu  1 , Feng-Yan Li  2 , Yue Chen  3 , Jia-Yuan Sun  2 , Huan-Xin Lin  2 , Qin Lin  4 , Zhen-Yu He  5
Affiliations

Therapeutic role of axillary lymph node dissection in patients with stage IV breast cancer: a population-based analysis

San-Gang Wu et al. J Cancer Res Clin Oncol. 2017 Mar.

Abstract

Purpose: To assess the clinical value of axillary lymph node (ALN) dissection in stage IV breast cancer.

Methods: Patients with a diagnosis of stage IV breast cancer from 1990 to 2010 were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were performed to analyze the effect of ALN dissection and ALN status on breast cancer-specific survival (BCSS) and overall survival (OS).

Results: A total of 11,645 patients were identified. Of these, 7358 (63.2%) patients underwent ALN dissection, and 6168 (83.8%) patients showed nodal positivity. During this time, the rate of ALN dissection increased. Patients with delayed diagnosis, age <50 years, poorly/undifferentiated disease, larger tumor size (>2 cm), and married women were more likely to undergo ALN dissection. ALN dissection was associated with improved BCSS and OS in multivariate analysis. ALN dissection improved the survival in patients with bone and liver metastasis, and patients with single site of distant metastasis also had survival benefit by ALN dissection. Lymph node staging based on the number of positive lymph nodes was the independent prognostic factor for BCSS and OS in multivariate analysis; patients with advanced lymph node staging had a poor survival.

Conclusions: ALN dissection may improve survival in patients with stage IV breast cancer who received primary tumor surgery, especially in patients with bone, liver, and single site of distant metastasis. The lymph node staging was also the prognostic factor in patients with stage IV breast cancer.

Keywords: Breast cancer; Lymph node dissection; Metastatic; SEER; Surgery.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Frequency of patients who underwent lymph node dissection, 1990–2010
Fig. 2
Fig. 2
Impact of lymph node dissection on breast cancer-specific survival (a) and overall survival (b) in stage IV breast cancer
Fig. 3
Fig. 3
Impact of lymph node staging on breast cancer-specific survival (a) and overall survival (b) in stage IV breast cancer
See this image and copyright information in PMC

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