Does the number of lymph nodes examined in patients with lymph node‐negative breast carcinoma have prognostic significance?

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Abstract
BACKGROUND: There are conflicting data on the prognostic significance of the number of lymph nodes examined in patients with lymph node‐negative breast carcinoma. Therefore, the authors analyzed the impact of the number of tumor‐free axillary lymph nodes on disease‐free survival (DFS) in two distinct patient populations.METHODS: Eight hundred thirty‐three consecutive patients with breast carcinoma who underwent mastectomy between 1927 and 1987 and 1094 consecutive patients with breast carcinoma who underwent with breast‐conservation therapy between 1984 and 2001 were diagnosed pathologically with negative axillary lymph node status. Patients were stratified into 4 groups according to the number of lymph nodes examined: Group 1 had 1–3 lymph nodes examined, Group 2 had 4–9 lymph nodes examined, Group 3 had 10–20 lymph nodes examined, and Group 4 had > 20 lymph nodes examined.RESULTS: In the mastectomy cohort, with a median follow‐up of 153 months, the 10‐year DFS rate was 70%, 65%, 79%, and 81% for Groups 1–4, respectively. On multivariate analysis, pathologic tumor size (P < 0.001) and the number of lymph nodes examined (P = 0.010) were significant predictors for long‐term DFS. In the breast‐conservation cohort, with a median follow‐up of 53 months, the 5‐year DFS rate was 90%, 91%, 92%, and 95% for Groups 1–4, respectively. On multivariate analysis, the only predictors of DFS were method of detection (clinically vs. mammographically) (P = 0.003) and tumor size (P = 0.035).CONCLUSIONS: The recovery of < 10 lymph nodes in lymph node‐negative patients who underwent mastectomy resulted in a 10–15% decreased long‐term DFS rate compared with patients who had a more extensive axillary assessment. However, the number of lymph nodes examined did not have an impact on the DFS rate in a contemporary cohort of patients who underwent breast‐conservation therapy, which included radiation. Cancer 2005. © 2005 American Cancer Society.