Table 3.

Association of lymphatic metastasis with distant metastasis and survival

			Correlation with survival
# of Patients	Time of observation	Comments	Disease free (DFS) ^a	Overall (OS) ^a	Reference
N/A ^b	N/A	Distant metastasis did not occur in the absence of lymph node metastasis in an experimental model	N/A	N/A	[121]
62,557	10 years	Ten-year DFS and OS were significantly lower in LN positive patients compared to those with pN0 (82.3% versus 91.9% and OS 68.1% versus 75.7%)	P<0.001	P<0.001	[65]
6,959	>10 years	Multivariate analysis adjusted for patient-, histopathologic-, and loco-regional therapeutic variables showed that LN positive patients had a significantly higher risk of death relative to negative cases	Not assessed	P<0.01	[53]
1,258	12 years	Both lymph node status and the presence of LVI were highly significant independent predictors of outcome	Not assessed	P<0.0001	[49]
1,126	9 years	Axillary metastasis developed in 18% of patients and significantly correlated with survival	P = 0.02	P = 0.01	[118]
939	>5 years	Nodal involvement and % positive nodes were the major factors for both OS and DFS with % positive nodes the most significant prognostic factor for survival	P<0.001	P<0.001	[233]
813	5 years	Node-negative patients survived 42 months after relapse compared with 20 months for patients with 1–3 nodes and 13 months for those having > 4 positive nodes	P<0.0001	P<0.0001	[66]
813	>75 years	62% of 813 patients had positive sLN. There was a significant difference in DFS and OS between patients who had 0–4 non-sentinel LN+ and those who had >5 non-sentinel LN+ suggesting that once the tumor passes sLN, it is much likely to spread systemically	P = 0.001	P = 0.003	[58]
453	6–65 months	A 10 year survival rate for patients with less than 14 nodes removed was 79% compared with 89% for patients with more than 14 nodes removed	P<0.0001	P=0.005	[117]
157 ^c*	9 years	Omission of axillary dissection occurred in 157 cases and correlated with reductions in OS, DFS, and breast cancer-specific survival in all patients	P<0.001	P<0.001	[118]
152	75 months	73% of node-negative patients were free of distant metastasis 5 years after diagnosis versus 48% of node- positive patients	P=0.01	P=0.03	[234]
130	5 years	Patients with intramammary metastases had poorer 5- year rates of DFS, disease-specific (66% vs. 90%; P = 0.001), and OS	P = 0.001	P = 0.004	[63]
122	>5 years	The size of the largest LN was associated with worse outcome in both univariate and multivariate analysis	P < .0001	P < .0001	[64]
118	10 years	91% of node-negative patients were free of distant metastasis versus 77% of node-positive patients	P = 0.001	Not assessed	[232]

P values for disease-free survival (DFS) and overall survival (OS).

N/A, not applicable.

157 patients from this study [118] who did not undergo axillary dissection were analyzed separately for survival. The effect of axillary dissection omission on survival is reported.