ABSTRACT

Background: Despite stage IV categorization, survival outcomes for breast cancer patients who experience contralateral axillary lymph node metastasis (CAM) remain uncertain. This study aimed to investigate the clinical outcomes for patients with metachronous CAM to provide insights into its prognosis and treatment recommendations.

Methods: This study retrospectively reviewed medical records of patients who underwent curative surgery for breast cancer and experienced CAM as the frst site of distant metastasis (DM) during the follow-up period between January 2001 and April 2023. Survival outcomes of the CAM patients were compared with those of breast cancer patients with other DM via propensity score-matching (PSM).

Results: The study identifed 40 breast cancer patients with metachronous CAM. The estimated 5-year overall survival (OS) was 39.6%, and the progression-free survival was 39.4%. The patients with CAM exhibited marginally better OS than the patients with DM (p = 0.071), but survival similar to that of the patients with isolated supraclavicular node recurrence (SCN) (p = 0.509). Moreover, matching of CAM with DM using two PSM models showed a consistently insignifcant survival diference (hazard ratio [HR], 1.47; p = 0.124 vs. HR, 1.19; p = 0.542). Ipsilateral breast tumor recurrences (IBTRs) were experienced by 12 patients before or concurrently with the CAM. These patients exhibited signifcantly better survival than the remaining patients (HR, 0.28; p = 0.024).

Conclusion: The breast cancer patients with CAM showed survival similar to that for the patients with DM, supporting the current stage IV classifcation of the CAM. However, CAM associated with IBTR exhibited superior survival outcomes, suggesting that this subset of CAM may beneft from treatments with curative intent.

Keywords Contralateral axillary metastasis · Breast cancer · Breast cancer surveillance · Locoregional recurrence · Distant metastasis