{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T11:58:36Z","timestamp":1776686316906,"version":"3.51.2"},"reference-count":22,"publisher":"FapUNIFESP (SciELO)","issue":"2","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: The aim of this study was to investigate the effect of capsule invasion on recurrence and survival in breast cancer patients with axillary lymph node metastases.  METHODS: This retrospective study included 135 breast cancer patients with axillary lymph node involvement who underwent surgery between 2009 and 2018. The relationships between capsule invasion and various clinicopathological factors\u2014including demographic parameters, tumor stage, surgical technique, histological type, number of involved lymph nodes, tumor size, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 index\u2014were analyzed using chi-square, Kaplan-Meier, and Fisher's exact tests. Additionally, multivariate Cox regression analysis was performed to assess the independent prognostic value of capsule invasion for recurrence. A p&lt;0.05 was considered statistically significant.  RESULTS: Capsular invasion was observed in 64 of 135 patients (47.4%). Recurrence occurred in six patients with capsule invasion compared to only one patient without capsule invasion. Multivariate Cox regression analysis, controlling for positive lymph node count, tumor size, grade, and receptor status, confirmed that capsule invasion was an independent predictor of recurrence [HR 3.45, 95%CI 1.12\u201310.65, p=0.032]. No significant association was found between tumor size and capsule invasion (p&gt;0.05). During follow-up, 20 patients died (9 with and 11 without capsule invasion), with no significant difference in 5-year survival or mean survival time between groups (p=0.972, Kaplan-Meier analysis). Grading of capsular invasion showed a significant correlation with recurrence (p=0.026).  DISCUSSION: Although lymph node capsule invasion in breast cancer with axillary lymph node involvement does not significantly impact overall survival, it independently and significantly elevates the risk of recurrence, as demonstrated by multivariate analysis.<\/jats:p>","DOI":"10.1590\/1806-9282.20251372","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T11:10:33Z","timestamp":1776683433000},"source":"Crossref","is-referenced-by-count":0,"title":["Effect of capsule invasion on recurrence and survival in axillary lymph node metastases of breast cancer"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-5872","authenticated-orcid":false,"given":"Nurhilal","family":"K\u0131z\u0131ltoprak","sequence":"first","affiliation":[{"name":"Sultan Abdulhamid Han Educational and Research Hospital,  T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9113-1011","authenticated-orcid":false,"given":"Ay\u015fe G\u00f6k\u00e7en","family":"Sade","sequence":"additional","affiliation":[{"name":"Sultan Abdulhamid Han Educational and Research Hospital,  T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8847-2963","authenticated-orcid":false,"given":"B\u00fclent","family":"G\u00fcle\u00e7","sequence":"additional","affiliation":[{"name":"Sultan Abdulhamid Han Educational and Research Hospital,  T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"9534","DOI":"10.1038\/s41598-021-88716-4","article-title":"Prognostic value of extranodal extension in axillary lymph node-positive breast cancer","volume":"11","author":"Ma X","year":"2021","journal-title":"Sci Rep"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"100216","DOI":"10.1016\/j.clinsp.2023.100216","article-title":"Measurement of extracapsular extension in sentinel lymph node as a possible predictor of residual axillary disease in breast cancer","volume":"78","author":"Freitas GB","year":"2023","journal-title":"Clinics (Sao Paulo)"},{"issue":"4","key":"ref3","doi-asserted-by":"crossref","first-page":"348","DOI":"10.6004\/jnccn.2018.7103","article-title":"Predictors of locoregional recurrence after failure to achieve pathologic complete response to neoadjuvant chemotherapy in triple-negative breast cancer","volume":"17","author":"Gabani P","year":"2019","journal-title":"J Natl Compr Canc Netw"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"104799","DOI":"10.1016\/j.oraloncology.2020.104799","article-title":"Staging and grading of oral squamous cell carcinoma: an update","volume":"107","author":"Almangush A","year":"2020","journal-title":"Oral Oncol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"7150304","DOI":"10.1155\/2022\/7150304","article-title":"Correlation analysis of pathological features and axillary lymph node metastasis in patients with invasive breast cancer","volume":"2022","author":"Chen H","year":"2022","journal-title":"J Immunol Res"},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"727","DOI":"10.21037\/gs-20-478","article-title":"The relationship between central lymph node metastasis and the distance from tumor to thyroid capsule in papillary thyroid microcarcinoma without capsule invasion","volume":"9","author":"Zhu M","year":"2020","journal-title":"Gland Surg"},{"issue":"4","key":"ref7","doi-asserted-by":"crossref","first-page":"218","DOI":"10.5152\/ejbh.2018.4038","article-title":"The significance of extent of extracapsular extension in patients with T1-2 and N1 breast cancer","volume":"14","author":"Kany\u0131lmaz G","year":"2018","journal-title":"Eur J Breast Health"},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1093\/ajcp\/65.4.439","article-title":"Pathologic findings from the national surgical adjuvant breast project. 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