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: Breast cancer is the most common malignancy among American women. Due to increased screening, the majority of patients present with early-stage breast cancer. The Oxford Overview Analysis demonstrates that adjuvant hormonal therapy and polychemotherapy reduce the risk of recurrence and death from breast cancer. Adjuvant systemic therapy, however, has associated risks and it would be useful to be able to optimally select patients most likely to benefit. The purpose of adjuvant systemic therapy is to eradicate distant micrometastatic deposits. It is essential therefore to be able to estimate an individual patient's risk of harboring clinically silent micrometastatic disease using established prognostic factors. It is also beneficial to be able to select the optimal adjuvant therapy for an individual patient based on established predictive factors. It is standard practice to administer systemic therapy to all patients with lymph node-positive disease. However, there are clearly differences among node-positive women that may warrant a more aggressive therapeutic approach. Furthermore, there are many node-negative women who would also benefit from adjuvant systemic therapy. Prognostic factors therefore must be differentiated from predictive factors. A prognostic factor is any measurement available at the time of surgery that correlates with disease-free or overall survival in the absence of systemic adjuvant therapy and, as a result, is able to correlate with the natural history of the disease. In contrast, a predictive factor is any measurement associated with response to a given therapy. Some factors, such as hormone receptors and HER2/neu overexpression, are both prognostic and predictive.The Oncologist 02/2004; 9(6):606-16. DOI:10.1634/theoncologist.9-6-606 · 4.54 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 08/2010; 7(4):246-252. DOI:10.1007/s11805-010-0526-8
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ABSTRACT: Evaluation of axillary lymph node status by sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND) are an inherent part of breast cancer treatment. Increased understanding of tumor biology has changed the prognostic and therapeutic impact of lymph node status. Non-invasive imaging techniques like axillary ultrasound, FDG-PET, or MRI revealed moderate sensitivity and high specificity in evaluation of lymph node status. Therefore, they are not sufficient for lymph node staging. Otherwise, the impact of remaining micrometastases and even macrometastases for prognosis and treatment decisions is overestimated. Considering tumor biology, the distinction of axillary metastases in isolated tumor cells (ITC, pN0(i+)); micrometastases (pN1mi), and macrometastases (pN1a) is not comprehensible. Increasing data support the thesis that remaining axillary metastases neither increase the axillary recurrence rate nor decrease overall survival. It is doubtful that axillary tumor cells are capable to complete the complex multistep metastatic process. If applied, axillary metastases are sensitive to systemic treatment and are targeted by postoperative tangential breast irradiation. Therefore, the controversy about the clinical relevance of tumor cell clusters or micrometastases in SLN is a sophisticated but not contemporary discussion. Currently, there is no indication for axillary surgery in elderly patients with favorable tumors and clinically tumor-free lymph nodes. Nonetheless, a rational and evidence-based approach to the management of clinically and sonographically N0 patients with planned breast-conserving surgery and limited tumor size is needed now.Breast Cancer Research and Treatment 04/2011; 128(3):613-24. DOI:10.1007/s10549-011-1532-0 · 4.20 Impact Factor