Implications of extranodal spread in node positive breast cancer: a reviewof survival and local recurrence

An evaluation of extra nodal spread (ENS) in predicting overall survival an d locoregional relapse rates in 311 node positive breast cancer patients wa s undertaken: the study group comprised 71 patients with ENS and the contro l group comprised 240 patients with no ENS. A review of pathology reports t hat described ENS was performed and a scoring system to categorize focal in volvement, extensive axillary fat involvement, and positive axillary surgic al margins was devised. Median follow up time was 3.1 years. Overall surviv al, disease specific survival and disease-free survival rates were signific antly worse in the study group in comparison with the control group. Poorer survival with more extensive pathological invasion of ENS was demonstrated Multivariate analysis of disease specific survival in those patient with 1 -3 involved lymph nodes demonstrated that ENS positivity was prognostically significant (P=0.013). Although locoregional relapse was increased in the presence of ENS, axillary relapses were uncommon and do not warrant axillar y radiation. (C) 2000 Harcourt Publishers Ltd.