Distribution und Relevanz cervikaler Lymphknotenmetastasen von Karzinomen der Mamma

Das Mammakarzinom ist der häufigste bösartige Tumor der Frau und die häufigste krebsbedingte Todesursache bei Frauen in Deutschland. Obwohl sich die Behandlungsstrategien während des letzten Jahrhunderts stark weiterentwickelt haben, sterben noch immer viele Patientinnen an der Erkrankung. Vor allem...

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Bibliographic Details
Main Author: Nauroth, Andreas
Contributors: Wiegand, Susanne (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2016
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Breast cancer is the leading type of cancer in women and the most common cause of cancer death in women in Germany. Although the treatment strategies have evolved considerably over the past century, many patients still die from the disease. Above all cases of locally advanced breast cancer, so-called LABC, represent a treatment problem. Patients who suffer from LABC, show an increased risk of local recurrence and development of distant metastases. The group of patients with LABC include those with supraclavicular lymph node metastases. Both the axillary, and the parasternal lymph drainage of the breast lead to these lymph nodes. According to the seventh edition of the AJCC Cancer Staging Manual such metastases are classified as N3C corresponding prognostic stage IIIC. Literature on supraclavicular metastases in breast cancer rarely includes information on the precise location and an assignment to the six cervical lymph node levels of the neck lacks for the most part. The aim of the present study was to examine a group of patients with supracla-vicular metastases who were treated in the University Department of Oto-Rhino-Laryngology in Marburg (Germany) with regard to patient characteristics and the distribution of metastases to the six neck regions in particular. For this reason the data of all patients presenting with suspected cervical lymph node metastases in breast cancer between 01.06.1998 and 20.03.2012 were evaluated retrospective-ly. In 25 patients a metastasis in the form of a supraclavicular recurrence was de-tected. The characteristics of the primary tumor were compared with those of the cervical metastasis. In particular, histopathological features such as perinodal growth, lymphangiosis- and hemangiosis carcinomatosa, and the receptor status of both estrogen and progesterone receptor and HER2/neu were observed. The time periods until the occurrence of relapse and the survival rates after relapse were analyzed. Due to the small total cohort an inferential statistical analysis was not warranted restricting the data analysis to descriptive statistical methods. The median time from initial diagnosis of the primary tumor until the occurrence of cervical recurrence was 55.2 months (M = 54.7, SD = 38.8) and the median sur-vival after diagnosis of recurrence was 25.2 months (M = 32.4, SD = 27.4). With regard to the distribution of the cervical lymph node metastasis values of 64%, 60%, 36% and 4% for the cervical level V, IV, III and II were detected. None of the patients suffered from metastasis in other cervical regions. Aggregating the cervi-cal level IV and V (according to the supraclavicular fossa) in one cluster, 92% of the patients showed metastases at this site. 36% of the patients had metastases cranial to the supraclavicular fossa, which in most cases were combined with me-tastases in the supraclavicular fossa. Only 8% of the patients had isolated metas-tases in the cranial cervical levels II and III. The number of cervical lymph node metastases varied between a minimum of one and a maximum of 18 metastases. At median three metastases were detected. When comparing the histopathological parameters of the primary tumor or its primary lymph node metastases and the metastases in the context of cervical recurrence, it was noted that the proportion of perinodal growth and lymphangiosis carcinomatosa were greater in cervical recurrence than in the primary tumor. In addition, the receptor status changed in 64% of the patients during the disease process. 48% showed a loss of the progesterone receptor and 24% a loss of the estrogen receptor. The HER2/neu was less variable in the disease process. These observations could be interpreted as signs of dedifferentiation of the tumor in the disease process and confirm the relevance of retesting the receptor status in recurrence. The knowledge of the receptor status is particularly important for the further treatment planning. Future research studies should incorporate larger sample sizes in order to investi-gate whether the localization of supraclavicular metastases is reflected in a differ-ing prognosis and whether there is a prognostic significance of receptor loss in disease progression. These questions could not be answered definitively by the present study because of the small patient sample. To answer the questions, therefore, the cooperation of several centers in terms of a multi-center study is needed.