Internal mammary lymph node recurrence: rare but characteristic metastasis site in breast cancer

BMC Cancer

Research Article

Zhimin Shao¹  Jingsong Lu¹  Peihua Wang²  Yajia Gu²  Shiangjiin Leaw³  Xichun Hu³  Lei Chen³  Zhonghua Wang³  Jiayi Chen⁴ 

[1] Department of Breast Surgery, Cancer Hospital of Fudan University, Shanghai Medical College, Shanghai, P.R. China;Department of Diagnostic Radiology, Cancer Hospital of Fudan University, Shanghai Medical College, Shanghai, P.R. China;Department of Medical Oncology, Cancer Hospital of Fudan University`, Shanghai Medical College, Shanghai, P.R. China;Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai Medical College, Shanghai, P.R. China;

关键词: Internal Mammary Lymph Node;    Axillary Lymph Node Involvement;    Internal Mammary Lymph Node Metastasis;    Supraclavicular Recurrence;    Internal Mammary Lymph Node Irradiation;   

DOI  :  10.1186/1471-2407-10-479

 received in 2010-01-18, accepted in 2010-09-07,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundTo assess the frequency of IMLN recurrence, its associated risk factors with disease-free interval (DFI) and its predicting factors on overall survival time.Methods133 cases of breast cancer IMLN recurrence were identified via the computerized CT reporting system between February 2003 and June 2008, during which chest CT for patients with breast cancer (n = 8867) were performed consecutively at Cancer Hospital, Fudan University, Shanghai, China. Patients' charts were retrieved and patients' characteristics, disease characteristics, and treatments after recurrence were collected for analysis. The frequency was 1.5% (133/8867).ResultsIMLN recurrence was presented as the first metastatic site in 121 (91%) patients while 88 (66.2%) had other concurrent metastases. Typical chest CT images included swelling of the IMLN at the ipsilateral side with local lump and sternal erosion located mostly between the second and third intercostal space. The median disease-free interval (DFI) of IMLN recurrence was 38 months. The independent factors that could delay the IMLN recurrence were small tumor size (HR 0.5 95%CI: 0.4 - 0.8; p = 0.002), and positive ER/PR disease (HR 0.6, 95% CI: 0.4 - 0.9; p = 0.006). The median survival time after IMLN recurrence was 42 months, with a 5-year survival rate of 30%. Univariate analysis showed four variables significantly influenced the survival time: DFI of IMLN recurrence (p = 0.001), no concurrent distant metastasis (p = 0.024), endocrine therapy for patients with positive ER/PR (p = 0.000), radiotherapy (p = 0.040). The independent factors that reduced the death risk were no concurrent distant metastases (HR: 0.7, 95% CI: 0.4 - 0.9; p = 0.031), endocrine therapy for patients with positive ER/PR status (HR: 0.2, 95% CI: 0.1 - 0.5; p = 0.001) and palliative radiotherapy (HR: 0.3, 95% CI: 0.1- 0.9; p = 0.026).ConclusionsThe risk of IMLN recurrence is low and there are certain characteristics features on CT images. ER/PR status is both a risk factor for DFI of IMLN recurrence and a prognostic factor for overall survival after IMLN recurrence. Patients with only IMLN recurrence and/or local lesion have a good prognosis.

【 授权许可】

Unknown   
© Chen et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.