Molecular pathological study of prognostic factor in node-negative breast cancer patients

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The most important subgroup of breast cancer patients for whom reliable prognostic factors are needed is women without axillary lymph node metastases. I investigated the clinical significance of occult micrometastases in axillary lymph nodes in 148 consecutive "node-negative" breast cancer patients. Occult micrometastases were detected in 21 of 148 patients (14.2%) by means of immunohistochemical analyses using cytokeratine antibodies and a single unstained section after routine histopathological examination. Log-rank tests showed that the 7-year disease-free survival (DFS) and overall survival (OS) rates by Kaplan-Meier methods were significantly better in patients without occult micrometastases than in patients with occult micrometastases (DFS; p=0.0009, OS; p=0.0001). According to Cox's multivariate analysis, the presence of occult micrometastases had the most significant effect on DFS (p=0.0053) and OS (P=0.0035). These findings suggest that the presence of occult micrometastases is an independent and significant predictor of clinical outcome, and that their immunohistochemical detection after routine histopathological examination is useful for selecting the "node-negative" breast cancer patient subgroup at high risk for relapse and death.