High dose morphine use in the hospice setting : A database survey of patient characteristics and effect on life expectancy

✍ Scribed by Peter Lawlor; Gary Frank

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 88 KB
• Volume: 89
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(20000701)89:1<220::aid-cncr30>3.0.co;2-y

✦ Synopsis

High Number of Tumor Free Axillary Lymph Nodes from Patients with Lymph Node Negative Breast Is Associated with Poor Outcome W e have read with interest the article by Camp et al., 1 in which they conclude that resection of Ն 20 negative axillary lymph nodes is associated with a poorer outcome in patients with invasive breast carcinoma independent of other known prognosticators (necrosis, tumor size, age, nuclear/histologic grade, and lymphovascular invasion). The study overall is small and only 23% of the patients (67 of 290 patients) had Ն 20 lymph nodes removed. Table 1 in their article indicated that although tumor necrosis was the only prognostic variable found significantly more often in the Ն 20 lymph node group, every adverse prognostic variable they listed (larger tumor size, younger age high grade, lymphovascular invasion, estrogen receptor/ progesterone receptor negativity, and aneuploidy) was without exception more frequent in the Ն 20 lymph node group than in those with fewer lymph nodes removed. 1 Although the authors hypothesize immunologic mechanisms to be the basis for the observed survival difference, they ignore the possibility of surgical selection bias. If the surgeon selectively removed more axillary lymph nodes based on unfavorable tumor characteristics, then the unfavorable characteristics and not the number of negative axillary lymph nodes removed may explain the poor outcome they observed. This in fact would appear to be the likelier explanation for their results.