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Jan 15, 2011 10:59PM
The study was looking at the relationship between number of lymph nodes removed and lymph node ratio, and survival and it found:
RESULTS: Node-negative patients with < 14 lymph nodes removed had a 10 year survival of 79% compared with 89% in patients with > or = 14 lymph nodes removed (P=0.005). The 10 year survival for patients with an LNR > or = 0.2 was 52%, compared with 73% for patients with an LNR < 0.2 (P<0.0001).
Doesn't that info alone make you want have more lymph nodes removed?
If I'm missing something, please explain!
I do find the abstract from San Antonio interesting, though perhaps not definitive. Two things that concern me: the study closed early due to low accrual/event rates...and I also wonder if the almost identical survival rates at 5 years have more to do with current chemo and hormonal treatments that "push" any relapses that will happen further into the future....Would love to see 10- and 15- year results!
EClaire: Yes, I think your oncologist will want to be more aggressive with your chemo/hormonal treatment if you have lots of positive nodes. There are currently three "levels" of chemo and as they increase in potential efficacy, they also increase in serious side effects. Also, the duration/intensity of your hormonal treatment might be affected by your nodal status. Put simply, the more nodes involved, the higher your chance of relapse and the more your doctor will want you to hit the cancer hard, with everything they've got, to keep you disease-free.
As a real-world example: I had an allergic reaction to my first Taxol and my doctor suggested I quit chemo then (after 4 AC and 1 Taxol) and go straight to Tamoxifen. She said that with 1 node positive, I don't have a super-high risk of recurrence, and there was a chance another Taxol treatment could send me into anaphylactic shock (which could kill me). Another woman told me that when she developed a rash after Taxol, her oncologist was like, "Sorry about that rash, but you've got to finish chemo" and that was because she had lots of positive nodes, so chemo was more crucial for keeping her cancer-free.
Also, now that I think about it, node number also comes into play for radiation. My radiation oncologist ultimately recommended skipping radiation of the axillary area and doing chest wall only, because my axillary was "treated" surgically, through the ALND (and radiation would increase my risk for lymphedema). If you have no positive nodes, or 1-3 nodes, you may or may not need axillary radiation (the dreaded "grey area") But if you have 4 or more positive nodes, they will definitely want to radiate that area.
Best of luck!
7/2010, IDC, 2cm, Stage IIb, Grade 3, 1/20 nodes, ER+/PR+, HER2-