Occult Metastases and Survival in Patients With Breast Cancer
Occult Metastases and Survival in Patients With Breast Cancer
Weaver DL, Ashikaga T, Krag DN, et al
N Engl J Med. 2011;364:412-421
What is the importance of occult metastases in axillary nodes of women with breast cancer? The study authors conducted a randomized trial comparing women who had sentinel node biopsy alone with women who had a complete axillary biopsy. Additional detailed pathologic information about occult metastatic disease in the axillary region was collected separately but was not revealed to the treating physicians. Approximately 16% of patients with proven breast cancer had occult metastatic disease. Although these women had a statistically reduced survival rate (P = .03), the observed difference in 5-year survival was extremely small -- only a 1.2% reduction.
The importance of occult metastatic axillary involvement that can be detected either by more assiduous sampling of sentinel nodes or by immunohistochemical analysis has always been questioned. This report demonstrates that, at least during the median follow-up period of 95 months, the difference in survival was extremely modest. However, it will be important to follow both groups of patients to determine whether the small survival difference in the presence of occult metastatic disease increases over a longer time period.
Abstract
Effect of Occult Metastases on Survival in Node-Negative Breast Cancer
Weaver DL, Ashikaga T, Krag DN, et al
N Engl J Med. 2011;364:412-421
Summary
What is the importance of occult metastases in axillary nodes of women with breast cancer? The study authors conducted a randomized trial comparing women who had sentinel node biopsy alone with women who had a complete axillary biopsy. Additional detailed pathologic information about occult metastatic disease in the axillary region was collected separately but was not revealed to the treating physicians. Approximately 16% of patients with proven breast cancer had occult metastatic disease. Although these women had a statistically reduced survival rate (P = .03), the observed difference in 5-year survival was extremely small -- only a 1.2% reduction.
Viewpoint
The importance of occult metastatic axillary involvement that can be detected either by more assiduous sampling of sentinel nodes or by immunohistochemical analysis has always been questioned. This report demonstrates that, at least during the median follow-up period of 95 months, the difference in survival was extremely modest. However, it will be important to follow both groups of patients to determine whether the small survival difference in the presence of occult metastatic disease increases over a longer time period.
Abstract
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