Micrometastases or isolated tumor cells and the outcome of breast cancer

Maaike De Boer, Carolien H M Van Deurzen, Jos A A M Van Dijck, George F. Borm, Paul J. Van Diest, Eddy M M Adang, Johan W R Nortier, Emiel J T Rutgers, Caroline Seynaeve, Marian B E Menke-Pluymers, Peter Bult, Vivianne C G Tjan-Heijnen

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The association of isolated tumor cells and micrometastases in regional lymph nodes with the clinical outcome of breast cancer is unclear. METHODS: We identified all patients in the Netherlands who underwent a sentinel-node biopsy for breast cancer before 2006 and had breast cancer with favorable primary-tumor characteristics and isolated tumor cells or micrometastases in the regional lymph nodes. Patients with node-negative disease were randomly selected from the years 2000 and 2001. The primary end point was disease-free survival. RESULTS: We identified 856 patients with node-negative disease who had not received systemic adjuvant therapy (the node-negative, no-adjuvant-therapy cohort), 856 patients with isolated tumor cells or micrometastases who had not received systemic adjuvant therapy (the node-positive, no-adjuvant-therapy cohort), and 995 patients with isolated tumor cells or micrometastases who had received such treatment (the nodepositive, adjuvant-therapy cohort). The median follow-up was 5.1 years. The adjusted hazard ratio for disease events among patients with isolated tumor cells who did not receive systemic therapy, as compared with women with node-negative disease, was 1.50 (95% confidence interval [CI], 1.15 to 1.94); among patients with micrometastases, the adjusted hazard ratio was 1.56 (95% CI, 1.15 to 2.13). Among patients with isolated tumor cells or micrometastases, the adjusted hazard ratio was 0.57 (95% CI, 0.45 to 0.73) in the node-positive, adjuvant-therapy cohort, as compared with the node-positive, no-adjuvant-therapy cohort. CONCLUSIONS: Isolated tumor cells or micrometastases in regional lymph nodes were associated with a reduced 5-year rate of disease-free survival among women with favorable early-stage breast cancer who did not receive adjuvant therapy. In patients with isolated tumor cells or micrometastases who received adjuvant therapy, disease-free survival was improved.

Original languageEnglish (US)
Pages (from-to)653-663
Number of pages11
JournalNew England Journal of Medicine
Volume361
Issue number7
DOIs
StatePublished - Aug 13 2009
Externally publishedYes

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Neoplasm Micrometastasis
Breast Neoplasms
Neoplasms
Therapeutics
Disease-Free Survival
Lymph Nodes
Confidence Intervals
Netherlands

ASJC Scopus subject areas

  • Medicine(all)

Cite this

De Boer, M., Van Deurzen, C. H. M., Van Dijck, J. A. A. M., Borm, G. F., Van Diest, P. J., Adang, E. M. M., ... Tjan-Heijnen, V. C. G. (2009). Micrometastases or isolated tumor cells and the outcome of breast cancer. New England Journal of Medicine, 361(7), 653-663. https://doi.org/10.1056/NEJMoa0904832

Micrometastases or isolated tumor cells and the outcome of breast cancer. / De Boer, Maaike; Van Deurzen, Carolien H M; Van Dijck, Jos A A M; Borm, George F.; Van Diest, Paul J.; Adang, Eddy M M; Nortier, Johan W R; Rutgers, Emiel J T; Seynaeve, Caroline; Menke-Pluymers, Marian B E; Bult, Peter; Tjan-Heijnen, Vivianne C G.

In: New England Journal of Medicine, Vol. 361, No. 7, 13.08.2009, p. 653-663.

Research output: Contribution to journalArticle

De Boer, M, Van Deurzen, CHM, Van Dijck, JAAM, Borm, GF, Van Diest, PJ, Adang, EMM, Nortier, JWR, Rutgers, EJT, Seynaeve, C, Menke-Pluymers, MBE, Bult, P & Tjan-Heijnen, VCG 2009, 'Micrometastases or isolated tumor cells and the outcome of breast cancer', New England Journal of Medicine, vol. 361, no. 7, pp. 653-663. https://doi.org/10.1056/NEJMoa0904832
De Boer M, Van Deurzen CHM, Van Dijck JAAM, Borm GF, Van Diest PJ, Adang EMM et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. New England Journal of Medicine. 2009 Aug 13;361(7):653-663. https://doi.org/10.1056/NEJMoa0904832
De Boer, Maaike ; Van Deurzen, Carolien H M ; Van Dijck, Jos A A M ; Borm, George F. ; Van Diest, Paul J. ; Adang, Eddy M M ; Nortier, Johan W R ; Rutgers, Emiel J T ; Seynaeve, Caroline ; Menke-Pluymers, Marian B E ; Bult, Peter ; Tjan-Heijnen, Vivianne C G. / Micrometastases or isolated tumor cells and the outcome of breast cancer. In: New England Journal of Medicine. 2009 ; Vol. 361, No. 7. pp. 653-663.
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abstract = "BACKGROUND: The association of isolated tumor cells and micrometastases in regional lymph nodes with the clinical outcome of breast cancer is unclear. METHODS: We identified all patients in the Netherlands who underwent a sentinel-node biopsy for breast cancer before 2006 and had breast cancer with favorable primary-tumor characteristics and isolated tumor cells or micrometastases in the regional lymph nodes. Patients with node-negative disease were randomly selected from the years 2000 and 2001. The primary end point was disease-free survival. RESULTS: We identified 856 patients with node-negative disease who had not received systemic adjuvant therapy (the node-negative, no-adjuvant-therapy cohort), 856 patients with isolated tumor cells or micrometastases who had not received systemic adjuvant therapy (the node-positive, no-adjuvant-therapy cohort), and 995 patients with isolated tumor cells or micrometastases who had received such treatment (the nodepositive, adjuvant-therapy cohort). The median follow-up was 5.1 years. The adjusted hazard ratio for disease events among patients with isolated tumor cells who did not receive systemic therapy, as compared with women with node-negative disease, was 1.50 (95{\%} confidence interval [CI], 1.15 to 1.94); among patients with micrometastases, the adjusted hazard ratio was 1.56 (95{\%} CI, 1.15 to 2.13). Among patients with isolated tumor cells or micrometastases, the adjusted hazard ratio was 0.57 (95{\%} CI, 0.45 to 0.73) in the node-positive, adjuvant-therapy cohort, as compared with the node-positive, no-adjuvant-therapy cohort. CONCLUSIONS: Isolated tumor cells or micrometastases in regional lymph nodes were associated with a reduced 5-year rate of disease-free survival among women with favorable early-stage breast cancer who did not receive adjuvant therapy. In patients with isolated tumor cells or micrometastases who received adjuvant therapy, disease-free survival was improved.",
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AU - De Boer, Maaike

AU - Van Deurzen, Carolien H M

AU - Van Dijck, Jos A A M

AU - Borm, George F.

AU - Van Diest, Paul J.

AU - Adang, Eddy M M

AU - Nortier, Johan W R

AU - Rutgers, Emiel J T

AU - Seynaeve, Caroline

AU - Menke-Pluymers, Marian B E

AU - Bult, Peter

AU - Tjan-Heijnen, Vivianne C G

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N2 - BACKGROUND: The association of isolated tumor cells and micrometastases in regional lymph nodes with the clinical outcome of breast cancer is unclear. METHODS: We identified all patients in the Netherlands who underwent a sentinel-node biopsy for breast cancer before 2006 and had breast cancer with favorable primary-tumor characteristics and isolated tumor cells or micrometastases in the regional lymph nodes. Patients with node-negative disease were randomly selected from the years 2000 and 2001. The primary end point was disease-free survival. RESULTS: We identified 856 patients with node-negative disease who had not received systemic adjuvant therapy (the node-negative, no-adjuvant-therapy cohort), 856 patients with isolated tumor cells or micrometastases who had not received systemic adjuvant therapy (the node-positive, no-adjuvant-therapy cohort), and 995 patients with isolated tumor cells or micrometastases who had received such treatment (the nodepositive, adjuvant-therapy cohort). The median follow-up was 5.1 years. The adjusted hazard ratio for disease events among patients with isolated tumor cells who did not receive systemic therapy, as compared with women with node-negative disease, was 1.50 (95% confidence interval [CI], 1.15 to 1.94); among patients with micrometastases, the adjusted hazard ratio was 1.56 (95% CI, 1.15 to 2.13). Among patients with isolated tumor cells or micrometastases, the adjusted hazard ratio was 0.57 (95% CI, 0.45 to 0.73) in the node-positive, adjuvant-therapy cohort, as compared with the node-positive, no-adjuvant-therapy cohort. CONCLUSIONS: Isolated tumor cells or micrometastases in regional lymph nodes were associated with a reduced 5-year rate of disease-free survival among women with favorable early-stage breast cancer who did not receive adjuvant therapy. In patients with isolated tumor cells or micrometastases who received adjuvant therapy, disease-free survival was improved.

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