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

2 Citations (Scopus)

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

Fingerprint

Observational Studies
Carcinogenesis
Retrospective Studies
Health
Neoplasms
Breast Neoplasms
Breast Cancer Lymphedema
Neoplasm Metastasis
Lymph Node Excision
Proportional Hazards Models
Survivors
Breast
Biomarkers
Lymph Nodes
Demography
Control Groups
Survival

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

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

In: BMC Cancer, Vol. 18, No. 1, 935, 29.09.2018.

Research output: Contribution to journalArticle

Invernizzi, Marco ; Corti, Chiara ; Lopez, Gianluca ; Michelotti, Anna ; Despini, Luca ; Gambini, Donatella ; Lorenzini, Daniele ; Guerini-Rocco, Elena ; Maggi, Stefania ; Noale, Marianna ; Fusco, Nicola. / 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. In: BMC Cancer. 2018 ; Vol. 18, No. 1.
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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.",
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T1 - Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema

T2 - An observational retrospective study with long-term follow-up 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis

AU - Invernizzi, Marco

AU - Corti, Chiara

AU - Lopez, Gianluca

AU - Michelotti, Anna

AU - Despini, Luca

AU - Gambini, Donatella

AU - Lorenzini, Daniele

AU - Guerini-Rocco, Elena

AU - Maggi, Stefania

AU - Noale, Marianna

AU - Fusco, Nicola

PY - 2018/9/29

Y1 - 2018/9/29

N2 - 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.

AB - 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.

KW - Axillary lymph nodes dissection

KW - Breast cancer

KW - Breast cancer related lymphoedema

KW - Extracapsular extension

KW - Lymphovascular invasion

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