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

M. Invernizzi, C. Corti, G. Lopez, A. Michelotti, L. Despini, D. Gambini, D. Lorenzini, E. Guerini-Rocco, S. Maggi, M. Noale, N. Fusco

Research output: Contribution to journalArticlepeer-review

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. © 2018 The Author(s).
Original languageEnglish
JournalBMC Cancer
Volume18
Issue number1
DOIs
Publication statusPublished - 2018

Keywords

  • Axillary lymph nodes dissection
  • Breast cancer
  • Breast cancer related lymphoedema
  • Extracapsular extension
  • Lymphovascular invasion
  • adult
  • aged
  • Article
  • axillary lymph node
  • breast cancer-related lymphedema
  • breast surgery
  • cancer localization
  • cancer risk
  • cancer staging
  • cancer survival
  • clinical assessment
  • clinical feature
  • clinical protocol
  • controlled study
  • disease association
  • disease free survival
  • extranodal tumor extension
  • female
  • follow up
  • histopathology
  • human
  • human tissue
  • long term care
  • lymph node dissection
  • lymph vessel metastasis
  • major clinical study
  • metastasis
  • observational study
  • prevalence
  • retrospective study
  • axilla
  • lymph node
  • middle aged
  • mortality
  • pathology
  • tumor invasion
  • very elderly
  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla
  • Breast Cancer Lymphedema
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision
  • Lymph Nodes
  • Middle Aged
  • Neoplasm Invasiveness
  • Retrospective Studies

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