Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer

Giuseppe Canavese, Alessandra Catturich, Carlo Vecchio, Daniela Tomei, Marco Gipponi, Paolo Bruzzi, Fausto Badellino

Research output: Contribution to journalArticlepeer-review


Aims. Clinical records of patients undergoing surgery for breast cancer were reviewed in order to evaluate the prognostic role of lymph-node level involvement. Methods. From 1982 to 1991, 1143 patients had radical mastectomy or conservative surgery with total axillary dissection: 461 patients of mean age 57.1 years (range: 25-89 years) were lymph-node positive (pN1); 369 patients (80%) had radical mastectomy; and 92 patients (20%) had conservative treatment plus post-operative radiotherapy, with the same mean number (n = 16) of lymph nodes collected in the surgical specimen. Data were analysed for the number of positive lymph nodes and level of involvement. Results. Level I, Levels I+II and Levels I+II+III were involved in 44.9, 18 and 21.4% of patients, respectively; 'skip metastases' occurred in 72 of 451 pN1 patients (15.5%). A univariate analysis showed that prognosis was directly related to the number of levels involved (P <0.001), and skip metastases had the same prognostic role as Level I involvement. The numbers of involved lymph-node levels and metastatic lymph nodes were well correlated; multivariate analysis showed that involvement of Levels I and III was independently correlated with prognosis. After adjustment for age and number of positive lymph nodes, the number of involved lymph-node levels was an independent prognostic factor, with highest predictability when all three lymph-node levels were positive (P = 0.009). Conclusions. The prognostic value of lymph-node status should be defined not only by the number of metastatic lymph nodes, but also by the number of levels of involvement.

Original languageEnglish
Pages (from-to)104-109
Number of pages6
JournalEuropean Journal of Surgical Oncology
Issue number2
Publication statusPublished - 1998


  • Breast cancer
  • Lymph-node level
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Surgery


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