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Clinical Significance of Micrometastases in Axillary Lymph Nodes Assessed by Reverse Transcription-Polymerase Chain Reaction in Breast Cancer Patients¹

Department of Surgery and Clinical Oncology, Graduate School of Medicine [N. M., Y. T., I. S., M. O., T. O., M. K., N. A., M. M.] and Institute for Molecular and Cellular Biology [K. O.], Osaka University, Osaka, 565-0871 Japan

ABSTRACT

We evaluated the clinical significance of micrometastases in axillary lymph nodes (AxLNs) of breast cancer patients for prediction of prognosis. Archived formalin-fixed paraffin-embedded AxLN specimens from 129 node-negative breast cancer patients diagnosed by routine H&E staining between 1986 and 1990 were subjected to carcinoembryonic antigen-specific reverse transcription-PCR analysis. Micrometastases were detected in 40 of 129 (31.0%) node-negative breast cancer patients. After a median follow-up period of 105.6 months, log-rank test analysis indicated that 10-year disease-free and overall survival rates by Kaplan-Meier methods were significantly better in patients without micrometastases than in patients with micrometastases [disease-free survival, 87.6% versus 66.1% (P = 0.0008); overall survival, 93.7% versus 67.8% (P = 0.0024)]. The presence of micrometastases in AxLNs was revealed by multivariate analyses to be an independent and significant predictor of clinical outcome. The hazard ratio was 3.992 (95% confidence interval, 1.293–12.323; P = 0.0161) for relapse and 4.293 (95% confidence interval, 1.043–17.675; P = 0.0436) for cancer-related death. The molecular staging of AxLNs using reverse transcription-PCR is useful for prediction of clinical outcome in early-stage breast cancer patients and can provide a powerful and sensitive complement to routine histopathological analysis.

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