PURPOSE:

1

• THE NUMBER OF AXILLARY NODES REMOVED AS A
  PREDICTOR OF REGIONAL RECURRENCE IN NODE NEGATIVE
  BREAST CANCER
• Olga Vujovic, MD1, Edward Yu, MD1, Anil Cherian,
  MD2, A. Rashid Dar, MD1, Larry Stitt, MSc3,
  Francisco Perera,MD1
• Department of Radiation Oncology1, London
  Regional Cancer Program, London Health Sciences
  Centre, London, ON, Canada
• Department of Medical Oncology2, London Regional
  Cancer Program, London Health Sciences Centre,
  London, ON, Canada
• Department of Biometry3, London Regional Cancer
  Program, London Health Sciences Centre, London,
  ON, Canada

ABSTRACT The Number Of Axillary Nodes Removed As
A Predictor Of Regional Recurrence In Node
Negative Breast Cancer Olga Vujovic, MD, Edward
Yu, MD, Anil Cherian, MD, A. Rashid Dar, MD,
Larry Stitt, MSc, Francisco Perera,
MD Departments of Radiation Oncology, Medical
Oncology and Biometry, London Regional Cancer
Program, London, ON, Canada Purpose To
determine if the number of axillary nodes removed
is a predictor of recurrence in node negative
breast cancer. Methods and Materials Five
hundred thirty-six patients with T1-T2, N0
invasive breast cancer, treated with lumpectomy
and axillary node dissection (AND), were reviewed
from January 1, 1986 to December 31, 1992.
Patients received radiation to whole breast only,
without regional nodal radiation. There was no
adjuvant chemotherapy or Tamoxifen given.
Patients were grouped according to the number of
axillary nodes dissected as follows 1-5 nodes
(91 patients), 6-10 nodes (225 patients) and gt10
nodes (220 patients). Hazard ratios and p-values
were determined for time to local recurrence,
regional recurrence, disease specific survival
and overall survival. Results Median follow-up
was 11.2 years. The overall local recurrence and
regional recurrence rates for the three groups
were 1-5 nodes 9.9 and 8.8 respectively,
6-10 nodes 10.2 and 2.2 respectively, and gt10
nodes 11.8 and 2.7 respectively. The effect
of number of axillary nodes removed was
statistically significant only for regional
recurrence (p0.017). There was no adverse
effect on disease specific survival
(p0.363). Conclusion The number of axillary
nodes removed predicts only for regional
recurrence in node negative breast cancer
patients, with less than 6 nodes removed
associated with higher regional recurrence. This
may have clinical implications with the current
practice of sentinel node biopsy (SNB) replacing
axillary node dissection in early stage breast
cancer.
Patients were grouped according to the number of
axillary nodes dissected as follows 1-5 nodes
(91 patients), 6-10 nodes (225 patients) and gt10
nodes (220 patients). Hazard ratios and p-values
were determined for time to local recurrence,
regional recurrence, disease specific survival
and overall survival.
PURPOSE To determine if the number of axillary
nodes removed is a predictor of recurrence in
node negative breast cancer. INTRODUCTION Lumpec
tomy or partial mastectomy plus axillary node
dissection (AND) has been the standard of care in
the surgical management of early stage breast
cancer for over two decades. Because of the
morbidity associated with AND, sentinel node
biopsy (SNB) which involves the excision of
usually 1-3 identified axillary sentinel nodes,
has recently replaced AND in node negative breast
cancer in many centers. This retrospective study
reviews the results with lumpectomy and AND at
the London Regional Cancer Program and looks at
the association between the number of axillary
nodes recovered and the local, regional and
survival rates with long-term follow-up.
Table II Effect of Number of Nodes
on Survival Outcomes
RESULTS Median follow-up was 11.2 years. The
overall local (ipsilateral breast) and regional
(nodal) recurrence rates for the three groups are
summarized in Table I. The effect of the number
of axillary nodes removed was statistically
significant only for regional recurrence
(p0.017). The 3, 5 and 10 year regional
recurrence rates for the three groups were 1-5
nodes 4.5, 4.5 and 8.5 respectively, 6-10
nodes 0.9, 1.9 and 1.9 respectively, and gt10
nodes 1.4, 1.9 and 2.5 respectively. The
effect of the number of axillary nodes removed on
survival is summarized in Table II. There was no
adverse effect on overall survival (p0.981) or
disease specific survival (p0.363).
 
 
CONCLUSION The number of axillary nodes removed
in node negative breast cancer patients predicts
for regional recurrence, with less than 6
axillary nodes removed associated with
significantly higher regional nodal recurrence.
This may have clinical implications with the
current practice of sentinel node biopsy (SNB)
replacing axillary node dissection in node
negative breast cancer. However, it will take
long-term follow-up, of at least 10 years, before
it is known whether we have replaced the
morbidity of AND with the morbidity of regional
nodal recurrence.  
Table I Effect of Number of Nodes on
Local and Regional Recurrence
MATERIALS AND METHOD Five hundred thirty-six
patients with T1-T2, N0 invasive breast cancer,
treated with lumpectomy and axillary node
dissection (AND), were reviewed from January 1,
1986 to December 31, 1992. Patients received
radiation to whole breast only, without regional
nodal radiation. There was no adjuvant
chemotherapy or Tamoxifen given.