BREAST CANCER PREDICTOR
[LIFE-SCI: Maastricht, August 13] More than 10 years ago, surgeons in the Netherlands introduced the sentinel node procedure in patients with early stage breast cancer. The sentinel lymph node is the first node that the breast tissue drains into. If this node is clean, no complementary axillary node treatment is necessary. Comprehensive examination of this node is thus a condition to prevent under treatment of the axillary lymph nodes. This intensified examination by the pathologist has resulted in the increased detection of micrometastases (ranging between 0.2 and 2.0 mm in size) and isolated tumor cells (individual tumor cells or tumor cell groups smaller than 0.2 mm). This raises the question: Are these small anomalies important for long-term outcome? And should we advise additional medical treatment at the time of the primary breast cancer diagnosis? Results The results of the MIRROR study ('Micrometastases and Isolated tumor cells: Relevant and Robust Or Rubbish') show that micromestastases and isolated tumor cells are associated with an absolute decline in five-year disease-free survival of 10%. For patients who are treated with medication after their operation, the prognosis improves by nearly 10%. "This study has produced results that we can work with", says Tjan-Heijnen, emphasizing the importance of the research. "It's the small step forward each time that will ultimately enable us to continuously improve the life expectancy for breast cancer patients. From this research we have learned that isolated tumor cells are important for the prognosis - just as important as micrometastases, in fact. To date these very small anomalies have been classified as lymph node-negative, but now we can show the world that they should be regarded as lymph node-positive." For this nationwide study, more than 3000 patients who had undergone a sentinel node procedure before 2006 were identified via the database of the Netherlands Cancer Registry. In total, 2700 patients fulfilled the criteria for the study. The women were then divided into three groups: one group without tumor cells in the nodes and who had not received additional medical treatment, one with isolated tumor cells or micrometastases in the nodes who neither had received additional treatment, and one with isolated tumor cells or micrometastases in the nodes who had received additional treatment. Their diagnosis, treatment and follow-up data were collected with the help of staff from the regional cancer centers, guided by the Comprehensive Cancer Center East. The steering committee was composed of representatives from the medical centers of all Dutch universities as well as the Netherlands Cancer Institute. The pathology slides of the sentinel lymph nodes were revised centrally in Utrecht and Nijmegen. All hospitals in the Netherlands took part in the research. Read more:
Patients diagnosed with breast cancer at an early stage often make a full recovery. To aid this effort, it is important that patients with risk factors be selected for additional medical treatments like chemotherapy and/or hormonal therapy. Until now, it had long been unclear whether the presence of micrometastases or isolated tumor cells in lymph nodes had a negative effect on the chances of recovery; thus, whether this should be a selection criterion for additional treatment. Researchers led by Professor Vivianne Tjan-Heijnen, head of the Internal Medicine Department's medical oncology section at the Maastricht University Medical Center+, have now shown that the presence of micrometastases or isolated tumor cells indeed lowers the chances of recovery. They have also established that survival chances increase through additional medical treatment. The results of their research have been published today in the authoritative American journal The New England Journal of Medicine.
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http://content.nejm.org/