Clinical Study of Breast Cancer Patients Who Had More Than 10 Positive Axillary Lymph Nodes

Kim, Je Ryong; Chang, Eil Sung

Abstract

PURPOSE
Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.