AXILLARY LYMPH DRAINAGE AS A PROGNOSTIC FACTOR OF SURVIVAL IN BREAST CANCER

Abstract

Axillary lymph node staging is an important prognostic factor in patients with breastcancer. The long-term survival is poor if the number of metastatic axillary lymph nodes exceedsthree. With 1-3 metastatic lymph nodes, survival in 30% of the patients is 20 years. The markedlydifferent outcome of these patients with metastatic axillary lymph nodes suggests that otherfactors likely play a critical role in breast cancer dissemination. In this study, we examined theassociation of impaired axillary lymph drainage with breast cancer survival. Fifty patients withbreast cancer underwent direct breast lymphography before treatment to evaluate the status ofipsilateral axillary lymph nodes and lymph drainage at time of presentation. Twenty-five patientswith signs of metastatic disease and/or impaired lymph drainage were followed for 10 years.Seven of 25 patients survived 10 years; 6 are tumor free; and 1 has distant mestastases. Theother 18 patients died during the 10 year period. Seventeen of the 18 died from disseminatedbreast cancer; 1 died of unrelated disease. In the survivors, direct breast lymphography showednormal breast lymph drainage. All patients with distant metastases had obstructed lymph vesselsat the time of original diagnosis. These findings suggest that the chance for survival isdetermined both by the status of axillary lymph drainage as well as the number of metastaticaxillary lymph nodes.