Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: An observational retrospective study with long-term follow-up 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis

Marco Invernizzi, Chiara Corti, Gianluca Lopez, Anna Michelotti, Luca Despini, Donatella Gambini, Daniele Lorenzini, Elena Guerini-Rocco, Stefania Maggi, Marianna Noale, Nicola Fusco

Research output: Contribution to journalArticle

Abstract

Background: Breast cancer related lymphoedema (BCRL) occurs in a substantial proportion of breast cancer survivors and is a major contributor to patients' disability. Regrettably, there are no validated predictive biomarkers, diagnostic tools, and strong evidence-supported therapeutic strategies for BCRL. Here, we provide an integrative characterization of a large series of women with node-positive breast cancers and identify new bona fide predictors of BCRL occurrence. Methods: Three hundred thirty-two cases of surgically-treated node-positive breast cancers were retrospectively collected (2-10.2 years of follow-up). Among them, 62 patients developed BCRL. To identify demographic and clinicopathologic features related to BCRL, Fisher's exact test or Chi-squared test were carried out for categorical variables; the Wilcoxon rank-sum was employed for continuous variables. Factors associated with BCRL occurrence were assessed using a Cox proportional hazards regression model. Results: En-bloc dissection of the axillary lymph nodes but not the type of breast surgery impacted on BCRL development. Most of BCRL patients had a Luminal A-like neoplasm. The median number of lymph nodes involved by metastatic deposits was significantly higher in BCRL compared to the control group (p = 0.04). Both peritumoral lymphovascular invasion (LVI) and extranodal extension (ENE) of the metastasis had a negative impact on BCRL-free survival (p = 0.01). Specifically, patients with LVI and left side localization harboured 4-fold higher risk of developing BCRL, while right axillary nodes metastases with ENE increased the probability of BCRL compared to ENE-negative patients. Conclusions: Assessment of LVI and ENE should be integrated with clinical and surgical data to improve BCRL risk stratification.

Original languageEnglish
Article number935
JournalBMC Cancer
Volume18
Issue number1
DOIs
Publication statusPublished - Sep 29 2018

Keywords

  • Axillary lymph nodes dissection
  • Breast cancer
  • Breast cancer related lymphoedema
  • Extracapsular extension
  • Lymphovascular invasion

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

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