Overall survival significantly associated with extent of disease. Median overall survival for entire cohort of 67 patients with IMN recurrences as a first event was 2.5 years, with 5-year overall survival 28%. Among 43 patients with concomitant distant metastases, median overall survival was 1.4 years, compared with 4.4 years for patients with other locoregional recurrence. Median overall survival was not reached for the 10 patients with isolated IMN failures. On log-rank test, difference between the 3 groups was highly significant, with P < .0001. Abbreviations: DM = distant metastases; IMN = internal mammary lymph node; OLR = other locoregional recurrence.