Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis

Alessia Nottegar, Nicola Veronese, Maheswari Senthil, R. M H Roumen, Brendon Stubbs, A. H. Choi, N. C. Verheuvel, M. Solmi, Antonio Pea, P. Capelli, Matteo Fassan, G. Sergi, E. Manzato, M. Maruzzo, Fabio Bagante, M. Koç, M. A. Eryilmaz, Emilio Bria, Luisa Carbognin, F. BonettiM. Barbareschi, Claudio Luchini

Research output: Contribution to journalReview article

Abstract

Invasive breast cancer is the most common malignancy in women. Its most common site of metastasis is represented by the lymph nodes of axilla, and the sentinel lymph node (SLN) is the first station of nodal metastasis. Axillary SLN biopsy accurately predicts axillary lymph node status and has been accepted as standard of care for nodal staging in breast cancer. To date, the morphologic aspects of SLN metastasis have not been considered by the oncologic staging system. Extranodal extension (ENE) of nodal metastasis, defined as extension of neoplastic cells through the nodal capsule into the peri-nodal adipose tissue, has recently emerged as an important prognostic factor in several types of malignancies. It has also been considered as a possible predictor of non-sentinel node tumor burden in SLN-positive breast cancer patients. We sought out to clarify the prognostic role of ENE in SLN-positive breast cancer patients in terms of overall and disease-free survival by conducting a systematic review and meta-analysis. Among 172 screened articles, 5 were eligible for the meta-analysis; they globally include 624 patients (163 ENE+ and 461 ENE−) with a median follow-up of 58 months. ENE was associated with a higher risk of both mortality (RR = 2.51; 95% CI: 1.66–3.79, p < 0.0001, I2 = 0%) and recurrence of disease (RR = 2.07, 95% CI: 1.38–3.10, p < 0.0001, I2 = 0%). These findings recommend the consideration of ENE from the gross sampling to the histopathological evaluation, in perspectives to be validated and included in the oncologic staging.

Original languageEnglish
Pages (from-to)919-925
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume42
Issue number7
DOIs
Publication statusPublished - Jul 1 2016

Keywords

  • Breast cancer
  • ENE
  • Extra-nodal
  • Extracapsular
  • Extranodal
  • Sentinel

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Nottegar, A., Veronese, N., Senthil, M., Roumen, R. M. H., Stubbs, B., Choi, A. H., Verheuvel, N. C., Solmi, M., Pea, A., Capelli, P., Fassan, M., Sergi, G., Manzato, E., Maruzzo, M., Bagante, F., Koç, M., Eryilmaz, M. A., Bria, E., Carbognin, L., ... Luchini, C. (2016). Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis. European Journal of Surgical Oncology, 42(7), 919-925. https://doi.org/10.1016/j.ejso.2016.02.259