Peritumoral Lymphovascular Invasion and Outcome Among Patients With Operable BC

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J Natl Cancer Inst. 2009 May 20;101(10):729-735, B Ejlertsen, M Jensen, F Rank, B Rasmussen, P Christiansen, N Kroman, M Kvistgaard, M Overgaard, D Toftdahl, H Mouridsen, on behalf of the Danish Breast Cancer Cooperative Group


ABSTRACT

Patients who have operable breast cancer and receive adjuvant systemic therapies gain an improvement in disease-free survival and overall survival. This benefit is quite small, however, for patients with low-risk disease. To avoid overtreatment and the toxicities of therapy, patients with low-risk disease are generally spared adjuvant systemic therapies. As a general rule, lymphovascular invasion is considered a marker of poor prognosis, but controversy remains as to whether its presence should justify moving patients from a low-risk category to a high-risk category. Currently, the National Institutes of Health guidelines do not include lymphovascular invasion as a criterion for determining which patients should be treated with adjuvant systemic therapy.
The Danish Breast Cancer Cooperative Group has been prospectively evaluating the prognostic importance of lymphovascular invasion in patients with operable breast cancer patients since 1996. The current study explores the prognostic significance of lymphovascular invasion in both low- and high-risk groups.
Overall, the presence of lymphovascular invasion was found to be associated with shorter overall survival (OS) and a shorter invasive-disease−free interval in the study population. However, when the patients were stratified based on risk group, the presence or absence of lymphovascular invasion was not associated with a statistically significantly difference in OS or invasive-disease−free interval in the low-risk group. In the high-risk group, the absence of lymphovascular invasion was associated with a statistically significant survival advantage, and the presence of lymphovascular invasion was associated with a shorter invasive-disease−free interval. The association between invasive-disease−free interval and OS was not influenced by the presence or absence of positive lymph nodes.
These study results confirm that lymphovascular invasion is a marker of poor prognosis in patients with early-stage breast cancer who have a high risk of recurrence. However, the study findings do not support the need to upstage low-risk patients to the high-risk category based on the presence of lymphovascular invasion alone.


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