Factors Associated With Node-Positive Disease in Estrogen Receptor-Positive Breast Cancer Patients

Julia Gallagher; Kelly M Elleson; Katherine Englander; Neha Chintapally; Weihong Sun; Junmin Whiting; Christine Laronga; Marie Catherine Lee

doi:10.1016/j.jss.2023.11.030

Factors Associated With Node-Positive Disease in Estrogen Receptor-Positive Breast Cancer Patients

J Surg Res. 2024 Mar:295:327-331. doi: 10.1016/j.jss.2023.11.030. Epub 2023 Dec 6.

Authors

Julia Gallagher¹, Kelly M Elleson², Katherine Englander¹, Neha Chintapally¹, Weihong Sun³, Junmin Whiting⁴, Christine Laronga³, Marie Catherine Lee⁵

Affiliations

¹ University of South Florida Morsani College of Medicine, Tampa, Florida.
² Regional Breast Care, Fort Myers, Florida; Genesis Care, Fort Myers, Florida.
³ Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida.
⁴ Moffitt Cancer Center and Research Institute, Department of Biostatistics and Bioinformatics, Tampa, Florida.
⁵ Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida. Electronic address: Marie.Lee@moffitt.org.

PMID: 38061237
DOI: 10.1016/j.jss.2023.11.030

Abstract

Introduction: Larger tumor size and shorter tumor-to-nipple distance at diagnosis are associated with greater risk of lymph node involvement in breast cancer. However, the relationship between receptor subtype status and lymph node metastasis remains unclear. Our objective was to examine the association between primary tumor size, location, and nodal metastasis across estrogen receptor (ER)+/ progesterone receptor (PR)+/ human epidermal growth factor receptor 2 (HER2)-, ER+/PR-/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2+ tumors.

Methods: A single-institution retrospective chart review was conducted of breast cancer patients diagnosed between 1998 and 2019 who underwent nodal evaluation during primary surgery. Neoadjuvant chemotherapy, pure ductal carcinoma in situ, inflammatory, recurrent, metastatic, bilateral, multicentric, and multifocal disease were excluded. Descriptive statistics (proportions and frequencies for categorical variables and medians [Q1-Q3] for continuous variables) were used to summarize patient characteristics. Kruskal-Wallis test was applied to test the association of outcome variables and continuous variables. Chi-square test or Fisher exact test was applied to test the association of outcome variables and categorical variables.

Results: Six hundred eighteen ER + patients had a median tumor size of 1.7 cm (1.1-2.5 cm). Two hundred ninety six out of 618 (47.9%) were node-positive and 188/618 (30.4%) had axillary dissection. Eighty four point three percent of patients were ER+/PR+/HER2-, 6.31% were ER+/PR-/HER2-, 6.96% were ER+/PR+/HER2+, and 1.13% were ER+/PR-/HER2+. Median tumor size was significantly larger in node-positive cases compared to node-negative cases in ER+/PR+/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2- subgroups. In ER+/PR+/HER2-patients, median tumor-nipple distance was significantly shorter in node-positive patients compared to node-negative patients. Upper outer quadrant location was significantly associated with nodal positivity in ER+/PR-/HER2- patients.

Conclusions: Across ER + patients, the significance between tumor size, location, and lymph node positivity varied significantly when differentiating by PR and HER2 status.

Keywords: Axillary lymph node dissection; Axillary lymph node metastasis; Breast cancer; Estrogen receptor.

MeSH terms

Biomarkers, Tumor / metabolism
Breast Neoplasms* / pathology
Female
Humans
Lymph Nodes / pathology
Lymphatic Metastasis
Receptor, ErbB-2 / metabolism
Receptors, Estrogen / metabolism
Receptors, Progesterone / metabolism
Retrospective Studies

Substances

Receptors, Estrogen
Receptor, ErbB-2
Receptors, Progesterone
Biomarkers, Tumor