Prognostic significance of number of positive nodes: a long-term study of one to two nodes versus three nodes in breast cancer patients.
ABSTRACT Previous reports of breast cancer have generally analyzed patients with one to three positive lymph nodes as a single group, often leading to controversy regarding the practical clinical applicability. The present study separately analyzed the survival outcomes of Stage T1-T2 breast cancer patients according to whether one, two, or three axillary nodes were pathologically positive.
The records of 5,996 patients were available for analysis from the population-based Saskatchewan provincial registry between 1981 and 1995. Because the reliability of the nodal assessment depends on the number of lymph nodes sampled, only those 755 patients with Stage T1-T2 disease and eight or more nodes examined were analyzed further for overall survival and cause-specific survival (CSS).
Patients with one and two positive nodes had nearly indistinguishable survival plots, but those with three positive nodes had a distinct trend toward worse survival. The overall survival rate of patients with one, two, and three nodes at 5, 10, and 15 years was 82.7%, 77.0%, and 79.0%, 64.8%, 60.9%, and 52.8%, and 48.8%, 48.0%, and 40.9%, respectively (p = .11). The corresponding CSS rates at 5, 10, and 15 years were 89.4%, 82.0%, and 81.3%, 78.87%, 72.9%, and 62.1%, and 72.7%. 69.0%, and 55.6% (p = .0004). The use of regional radiotherapy did not confer any apparent survival benefit in terms of either overall survival or CSS.
Patients with one or two positive nodes had a similar CSS. However, those with three positive nodes fared worse, with a significantly reduced CSS compared with those with one or two involved nodes. Thus, the survival data among patients with one to three nodes positive reveals clearly relevant differences when analyzed separately.
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ABSTRACT: PURPOSE: To determine whether patients with 1, 2, or 3 positive lymph nodes (LNs) have similar survival outcomes. METHODS AND MATERIALS: We analyzed the Surveillance, Epidemiology, and End Results registry of breast cancer patients diagnosed between 1990 and 2003. We identified 10,415 women with T1-2N1M0 breast cancer who were treated with mastectomy with no adjuvant radiation, with at least 10 LNs examined and 6 months of follow-up. The Kaplan-Meier method and log-rank test were used for survival analysis. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS: Median follow-up was 92 months. Ten-year overall survival (OS) and cause-specific survival (CSS) were progressively worse with increasing number of positive LNs. Survival rates were 70%, 64%, and 60% (OS), and 82%, 76%, and 72% (CSS) for 1, 2, and 3 positive LNs, respectively. Pairwise log-rank test P values were <.001 (1 vs 2 positive LNs), <.001 (1 vs 3 positive LNs), and .002 (2 vs 3 positive LNs). Multivariate analysis showed that number of positive LNs was a significant predictor of OS and CSS. Hazard ratios increased with the number of positive LNs. In addition, age, primary tumor size, grade, estrogen receptor and progesterone receptor status, race, and year of diagnosis were significant prognostic factors. CONCLUSIONS: Our study suggests that patients with 1, 2, and 3 positive LNs have distinct survival outcomes, with increasing number of positive LNs associated with worse OS and CSS. The conventional grouping of 1-3 positive LNs needs to be reconsidered.International journal of radiation oncology, biology, physics 12/2012; · 4.59 Impact Factor
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ABSTRACT: ObjectiveTo identify risk factors for relapse and death in patients with T1 to T2 breast cancer with 0–3 positive axillary lymph nodes. MethodsThe case files of 540 breast cancer patients with T1–T2 tumors with 0–3 positive nodes were reviewed retrospectively. Ten-year locoregional recurrence (LRR), distant recurrence (DR), disease-free survival (DFS) and overall survival (OS) of the patients were analyzed. Univariate statistical analysis and Cox proportional hazards models were carried out with SPSS so ware v.16.0. ResultsThe median follow-up of all the patients was 7.2 years. On multivariate analysis, > 20% positive axillary nodes was the only variable that influenced LRR adversely (hazard ratio[HR], 12.816; 95% confidence interval, 4.657–35.266, P < 0.001); > 20% positive axillary nodes and ductal carcinoma were variables that influenced DR adversely (HR, 11.088, 95% confidence interval, 3.807–32.297, P < 0.001; HR, 0.390, 95% confidence interval, 0.179–0.851, P = 0.018); 1–3 positive axillary nodes and > 20% positive axillary nodes were the only variables that had negative effect on 10-year OS (HR, 2.110, 95% confidence interval, 1.364–3.264, P = 0.001; HR, 10.244, 95% confidence interval, 3.497–30.011, P < 0.001) and they were also adverse prognostic variables on 10-year DFS (HR, 1.634, 95% confidence interval, 1.171–2.279, P = 0.004; HR, 7.339, 95% confidence interval, 2.906–18.530, P < 0.001). ConclusionAxillary lymph nodal status is the only risk factor with a significant impact on 10-year LRR, DR, OS and DFS. Patients with T1–T2 breast cancer with 0–3 positive lymph nodes have the LRR and DR of over 10 years, and the OS and DFS of less than 10 years, compared to patients with negative lymph nodes. Histology in primary tumors is a significant prognostic factor for the 10-year DR. Key Wordsbreast neoplasms-recurrence-death-prognosis-lymph nodesClinical Oncology and Cancer Research 7(4):246-252.
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ABSTRACT: The role of surgeons in the treatment of Merkel cell carcinoma (MCC) of the skin is reviewed, with respect to diagnosis and treatment. Most of the data in the literature are case reports. Surgery is the mainstay of treatment. A wide local excision, with sentinel node (SLN) biopsy, is the recommended treatment of choice. If SLN is involved, nodal dissection should be performed; unless patient is unfit, then regional radiotherapy can be given. Surgeons should always refer patients for assessment of the need for adjuvant treatments. Adjuvant radiotherapy is well tolerated and effective to minimize recurrence. Adjuvant chemotherapy may be considered for selected node-positive patients, as per National Comprehensive Cancer Network guideline. Data are insufficient to assess whether adjuvant chemotherapy improves survival. Recurrent disease should be treated by complete surgical resection if possible, followed by radiotherapy and possibly chemotherapy. Generally results of multimodality treatment for recurrent disease are better than lesser treatments. Future research should focus on newer chemotherapy and molecular targeted agents in the adjuvant setting and for gross disease.ISRN surgery. 01/2013; 2013:850797.