Level of axillary involvement by lymph node metastases from breast cancer is not an independent predictor of survival

About half of all patients with stage I or stage II breast cancer have metastatic spread of cancer to the axillary (armpit) lymph nodes. Excision of these nodes, routinely performed to remove metastasis, provides information on prognosis and used to select patients for chemo- and radiation therapy. The presence and number of metastatic lymph nodes is an indicator of prognosis. Axillary lymph node metastasis may be divided into three anatomic levels indicating their proximity to the pectoralis minor muscle of the upper chest wall. The prognostic value of the anatomic level of metastatic involvement remains controversial. A study was undertaken of 135 patients with breast cancer to determine the prognostic significance of the level of axillary node metastasis. Patients had stage I or stage II cancer and underwent either a modified radical mastectomy (removal of the breast) or lumpectomy (removal of the lump) with removal of axillary nodes and radiotherapy. Seventy-one patients had no axillary metastasis. The average patient follow-up was 6.9 years. It was found that there was no significant difference in survival or disease-free survival between patients whose highest level of metastasis was level I compared with patients whose highest level was level II. Patients with level III involvement did have significantly worse survival. However, when these patients were grouped by total number of metastatic lymph nodes, there was no difference in overall survival compared with patients with level I or level II involvement. These results show that for patients with stage II breast cancer, the level of node involvement is not an independent predictor of survival. (Consumer Summary produced by Reliance Medical Information, Inc.)