J Breast Cancer.  2006 Jun;9(2):127-133. 10.4048/jbc.2006.9.2.127.

The Prognosis of Breast Cancer Patients with 10 or more Positive Lymph Nodes

Affiliations
  • 1Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea. nohwoo@kcch.re.kr
  • 2Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea.
  • 3Department of Therapeutic Radiology & Oncology, Korea Cancer Center Hospital, Seoul, Korea.

Abstract

PURPOSE
According to the staging system for breast cancer by the 2003 revised American Joint Committee on Cancer (AJCC), the patients with 10 or more positive axillary nodes are classified as N3 and also as a new stage, i.e., stage IIIC. The aim of this study was to investigate the prognosis of patients with 10 or more positive nodes.
METHODS
The database of 125 patients with 10 or more positive axillary nodes who underwent surgery at Korea Cancer Center Hospital between 1997 and 2001 were reviewed. The age of the patients, the T stage, the number and site of the positive nodes, the hormone receptor status, the HER-2 over-expression, and the treatment modalities were examined in reference to the disease-free survival (DFS).
RESULTS
At the median follow-up time of 40 months, 16 cases (13%) of locoregonal recurrence and 57 cases (46%) of systemic relapse had developed in 67 patients (54%). The DFS and overall survival rates at 5 years were 46% and 55%, respectively. On univariate analysis, the T stage (p<0.001), hormone receptor status (p=0.001), and neoadjuvant chemotherapy (p=0.014) were predictive factors of recurrence. On multivariate analysis, the T stage (p=0.002) and hormone receptor status (p=0.02) were independent predictors of recurrence. The patients with hormone receptor positive tumor had a 58%, 5-year DFS rate. On the contrary, in 9 of 10 patients with T4 tumor, recurrence developed within 2 years after the initial treatment.
CONCLUSIONS
This study showed that stage IIIC according to the revised AJCC staging system was not a prognostically homogeneous group. Some notably high survival rates were observed in a subgroup of patients, and especially for those patients with hormone receptor positive tumor. In contrast, the prognosis of patients with T4 tumor was significantly worse than that of the patients with the other stage IIIC disease. Thus, we suggest that the stage IIIC group in the new AJCC staging system needs to be refined to provide more reliable prognostic information for the patients with advanced breast cancer.

Keyword

Breast neoplasms; Neoplasm staging; Prognosis

MeSH Terms

Breast Neoplasms*
Breast*
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Joints
Korea
Lymph Nodes*
Multivariate Analysis
Neoplasm Staging
Prognosis*
Recurrence
Survival Rate

Reference

1. Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, et al. Staging system for breast cancer: revision for the 6th edition of the AJCC Cancer Staging Manual. Surg Clin North Am. 2003. 83:803–819.
Article
2. Jeon YS, Kang SH, Lee SJ. Comparison between the 5th and 6th American Joint Committee on Cancer(AJCC) staging system in 1,275 breast cancer patients. J Korean Surg Soc. 2004. 67:175–182.
3. Woodward WA, Storm EA, Tucker SL, McNeese MD, Perkins GH, Schechter NR, et al. Changes in the 2003 American Joint Committee on Cancer Staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol. 2003. 21:3244–3248.
Article
4. Duraker N, Caynak ZC. Prognostic value of the 2002 TNM classification for breast carcinoma with regard to the number of metastatic axillary lymph nodes. Cancer. 2005. 104:700–707.
Article
5. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1988. 63:181–187.
Article
6. Nemoto T, Vana J, Bedwani RN, Baker HW, McGregor FH, Murphy GP. Management and survival of female breast cancer. results of a national survey by the American College of Surgeons. Cancer. 1980. 45:2917–2924.
Article
7. Paik S, Bryant J, Park C, Fisher B, Tan-Chiu E, Hyams D, et al. erbB-2 and response to doxorubicin in patients with axillary lymph node-positive, hormone receptor-negative breast cancer. J Natl Cancer Inst. 1998. 90:1361–1370.
Article
8. Crump M, Goss PE, Prince M, Girouard C. Outcome of extensive evaluation before adjuvant therapy in women with breast cancer and 10 or more positive axillary lymph nodes. J Clin Oncol. 1996. 14:66–69.
Article
9. Diab SG, Hilsenbeck SG, de Moor C, Clark GM, Osborne CK, Ravdin PM, et al. Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy. J Clin Oncol. 1998. 16:1655–1660.
Article
10. Fountzilas G, Nicolaides C, Aravantinos G, Skarlos D, Kosmidis P, Papakostas P, et al. Dose-dense adjuvant chemotherapy with epirubicin monotherapy in patients with operable breast cancer and ≥ 10 positive axillary lymph nodes: A feasibility study. Oncology. 1998. 55:508–512.
Article
11. Kim JR, Chang ES. Clinical study of breast cancer patients who had more than 10 positive axillary lymph nodes. J Breast Cancer. 2005. 8:76–82.
Article
12. Walker MJ, Osborne MD, Young DC, Schneebaum S, La Valle GJ, Farrar WB. The natural history of breast cancer with more than 10 positive nodes. Am J Surg. 1995. 169:575–579.
Article
13. Weiss RB, Woolf SH, Demakos E, Holland JF, Berry DA, Falkson G, et al. Natural history of more than 20 years of node-positive primary breast carcinoma treated with cyclophosphamide, methotrexate, and fluorouracil-based adjuvant chemotherapy: A study by the Cancer and Leukemia Group B. J Clin Oncol. 2003. 21:1825–1835.
Article
14. Montero AJ, Rouzier R, Lluch A, Theriault RL, Buzdar AU, Delaloge S, et al. The natural history of breast carcinoma in Patients with ≥ 10 metastatic axillary lymph nodes before and after the advent of adjuvant therapy. Cancer. 2005. 104:229–235.
Article
15. Low JA, Berman AW, Steinberg SM, Danforth DN, Lippman ME, Swain SA. Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy. J Clin Oncol. 2004. 22:4067–4074.
Article
16. Kleer CG, Zhang Y, Pan Q, van Golen KL, Wu ZF, Livant D, et al. WISP3 is a novel tumor suppressor gene of inflammatory breast cancer. Oncogene. 2002. 21:3172–3180.
Article
17. Kleer CG, van Golen KL, Zhang Y, Wu ZF, Rubin MA, Merajver SD. Characterization of RhoC expression in benign and malignant breast disease: a potential new marker for small breast carcinomas with metastatic ability. Am J Pathol. 2002. 160:579–584.
Article
18. Buzdar Au, Kau SW, Hortobagyi GN, Ames FC, Holmes FA, Fraschini G, et al. Clinical course of patients with breast cancer with ten or more positive nodes who were treated with doxorubicin-containing adjuvant therapy. Cancer. 1992. 69:448–452.
Article
19. Tsuchiya A, Kanno M, Abe R. The impact of lymph node metastases on the survival of breast cancer patients with ten or more positive lymph nodes. Surg Today. 1997. 27:902–906.
Article
20. Haagensen CD. Disease of the breast. 1986. 3rd ed. Philadelphia: W.B. Saunders;640–643.
21. Yang JH, Lee JK, Hong KC, Woo ZH. Significance of axillary lymph node level metastasis in operable breast cancer. J Korean Surg Soc. 1992. 42:770–775.
22. Dahl-Iversen E. An extended radical operation for carcinoma of the breast: reflections and results. J R Coll Surg Edinb. 1963. 8:81–90.
23. Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, et al. TAC improves disease-free survial and overall survival over FAC in node-positive early breast cancer patients. BCIRG 001: 55months follow-up. 26th Annual San Antonio Breast Cancer Symposium[abstract]. Breast Cancer Res Treat. 2003. 81:43.
Full Text Links
  • JBC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr