Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes

Jun Sang Lee, Seung Il Kim, So Young Choi, Hyung Seok Park, Jong Seok Lee, Seho Park, Jaseung Koo, Byeong Woo Park, Kyong Sik Lee

Research output: Contribution to journalArticle

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Abstract

Background: The purpose of this study was to investigate prognostic factors in breast cancer patients with metastasis of ten or more lymph nodes (pathologic N3a). Methods: We conducted a retrospective analysis of the cases of 304 breast cancer patients with pathologic N3a disease who had undergone definitive surgery between 1986 and 2006, and investigated the correlation between clinicopathologic characteristics and treatment outcomes. Results: With a median follow-up period of 55 months, the 5-year disease-free survival rate was 42.9% and the overall survival rate was 57.8%. Univariate analysis showed that the factors associated with poor disease-free survival were: age < 35 years (P = 0.001), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P<0.001), 20 or more positive lymph nodes (P<0.001), presence of lymphovascular invasion (P = 0.003), and negative progesterone receptor expression (P = 0.003). Multivariate analysis showed the factors with independent prognostic significance to be: history of neoadjuvant chemotherapy (hazard ratio [HR] 3.163; 95% confidence interval [CI], 2.025-4.941; P<0.001), 20 or more positive nodes (HR 1.598; 95% CI, 1.063-2.402; P = 0.024), and presence of lymphovascular invasion (HR 1.636; 95% CI, 1.009-2.654; P = 0.046). Factors associated with poor overall survival in univariate analysis were: age <35 years (P = 0.033), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P = 0.001), 20 or more positive lymph nodes (P<0.001), and negative progesterone receptor expression (P = 0.013). Multivariate analysis showed these factors to be: history of neoadjuvant chemotherapy (HR 2.900; 95% CI, 2.011-4.182; P<0.001), and 20 or more positive nodes (HR 1.956; 95% CI, 1.419-2.696; P<0.001). Conclusion: Cases of breast tumors with extensive nodal metastasis were found to be heterogeneous in terms of prognosis. History of previous neoadjuvant chemotherapy and higher numbers of metastatic lymph nodes were found to be the two most important prognostic markers for pathologic N3a disease. New strategies such as biologic therapy and novel combinations should be considered for application in patients with poor prognosis, rather than conventional treatment.

Original languageEnglish
Pages (from-to)473-481
Number of pages9
JournalInternational Journal of Clinical Oncology
Volume16
Issue number5
DOIs
Publication statusPublished - 2011 Oct 1

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Lymph Nodes
Confidence Intervals
Breast Neoplasms
Drug Therapy
Progesterone Receptors
Disease-Free Survival
Multivariate Analysis
Survival Rate
Neoplasm Metastasis
Biological Therapy
Statistical Factor Analysis
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hematology
  • Oncology

Cite this

Lee, Jun Sang ; Kim, Seung Il ; Choi, So Young ; Park, Hyung Seok ; Lee, Jong Seok ; Park, Seho ; Koo, Jaseung ; Park, Byeong Woo ; Lee, Kyong Sik. / Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes. In: International Journal of Clinical Oncology. 2011 ; Vol. 16, No. 5. pp. 473-481.
@article{6284631ce99c4b9ab49116d6d24995da,
title = "Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes",
abstract = "Background: The purpose of this study was to investigate prognostic factors in breast cancer patients with metastasis of ten or more lymph nodes (pathologic N3a). Methods: We conducted a retrospective analysis of the cases of 304 breast cancer patients with pathologic N3a disease who had undergone definitive surgery between 1986 and 2006, and investigated the correlation between clinicopathologic characteristics and treatment outcomes. Results: With a median follow-up period of 55 months, the 5-year disease-free survival rate was 42.9{\%} and the overall survival rate was 57.8{\%}. Univariate analysis showed that the factors associated with poor disease-free survival were: age < 35 years (P = 0.001), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P<0.001), 20 or more positive lymph nodes (P<0.001), presence of lymphovascular invasion (P = 0.003), and negative progesterone receptor expression (P = 0.003). Multivariate analysis showed the factors with independent prognostic significance to be: history of neoadjuvant chemotherapy (hazard ratio [HR] 3.163; 95{\%} confidence interval [CI], 2.025-4.941; P<0.001), 20 or more positive nodes (HR 1.598; 95{\%} CI, 1.063-2.402; P = 0.024), and presence of lymphovascular invasion (HR 1.636; 95{\%} CI, 1.009-2.654; P = 0.046). Factors associated with poor overall survival in univariate analysis were: age <35 years (P = 0.033), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P = 0.001), 20 or more positive lymph nodes (P<0.001), and negative progesterone receptor expression (P = 0.013). Multivariate analysis showed these factors to be: history of neoadjuvant chemotherapy (HR 2.900; 95{\%} CI, 2.011-4.182; P<0.001), and 20 or more positive nodes (HR 1.956; 95{\%} CI, 1.419-2.696; P<0.001). Conclusion: Cases of breast tumors with extensive nodal metastasis were found to be heterogeneous in terms of prognosis. History of previous neoadjuvant chemotherapy and higher numbers of metastatic lymph nodes were found to be the two most important prognostic markers for pathologic N3a disease. New strategies such as biologic therapy and novel combinations should be considered for application in patients with poor prognosis, rather than conventional treatment.",
author = "Lee, {Jun Sang} and Kim, {Seung Il} and Choi, {So Young} and Park, {Hyung Seok} and Lee, {Jong Seok} and Seho Park and Jaseung Koo and Park, {Byeong Woo} and Lee, {Kyong Sik}",
year = "2011",
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doi = "10.1007/s10147-011-0207-5",
language = "English",
volume = "16",
pages = "473--481",
journal = "International Journal of Clinical Oncology",
issn = "1341-9625",
publisher = "Springer Japan",
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Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes. / Lee, Jun Sang; Kim, Seung Il; Choi, So Young; Park, Hyung Seok; Lee, Jong Seok; Park, Seho; Koo, Jaseung; Park, Byeong Woo; Lee, Kyong Sik.

In: International Journal of Clinical Oncology, Vol. 16, No. 5, 01.10.2011, p. 473-481.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes

AU - Lee, Jun Sang

AU - Kim, Seung Il

AU - Choi, So Young

AU - Park, Hyung Seok

AU - Lee, Jong Seok

AU - Park, Seho

AU - Koo, Jaseung

AU - Park, Byeong Woo

AU - Lee, Kyong Sik

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Background: The purpose of this study was to investigate prognostic factors in breast cancer patients with metastasis of ten or more lymph nodes (pathologic N3a). Methods: We conducted a retrospective analysis of the cases of 304 breast cancer patients with pathologic N3a disease who had undergone definitive surgery between 1986 and 2006, and investigated the correlation between clinicopathologic characteristics and treatment outcomes. Results: With a median follow-up period of 55 months, the 5-year disease-free survival rate was 42.9% and the overall survival rate was 57.8%. Univariate analysis showed that the factors associated with poor disease-free survival were: age < 35 years (P = 0.001), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P<0.001), 20 or more positive lymph nodes (P<0.001), presence of lymphovascular invasion (P = 0.003), and negative progesterone receptor expression (P = 0.003). Multivariate analysis showed the factors with independent prognostic significance to be: history of neoadjuvant chemotherapy (hazard ratio [HR] 3.163; 95% confidence interval [CI], 2.025-4.941; P<0.001), 20 or more positive nodes (HR 1.598; 95% CI, 1.063-2.402; P = 0.024), and presence of lymphovascular invasion (HR 1.636; 95% CI, 1.009-2.654; P = 0.046). Factors associated with poor overall survival in univariate analysis were: age <35 years (P = 0.033), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P = 0.001), 20 or more positive lymph nodes (P<0.001), and negative progesterone receptor expression (P = 0.013). Multivariate analysis showed these factors to be: history of neoadjuvant chemotherapy (HR 2.900; 95% CI, 2.011-4.182; P<0.001), and 20 or more positive nodes (HR 1.956; 95% CI, 1.419-2.696; P<0.001). Conclusion: Cases of breast tumors with extensive nodal metastasis were found to be heterogeneous in terms of prognosis. History of previous neoadjuvant chemotherapy and higher numbers of metastatic lymph nodes were found to be the two most important prognostic markers for pathologic N3a disease. New strategies such as biologic therapy and novel combinations should be considered for application in patients with poor prognosis, rather than conventional treatment.

AB - Background: The purpose of this study was to investigate prognostic factors in breast cancer patients with metastasis of ten or more lymph nodes (pathologic N3a). Methods: We conducted a retrospective analysis of the cases of 304 breast cancer patients with pathologic N3a disease who had undergone definitive surgery between 1986 and 2006, and investigated the correlation between clinicopathologic characteristics and treatment outcomes. Results: With a median follow-up period of 55 months, the 5-year disease-free survival rate was 42.9% and the overall survival rate was 57.8%. Univariate analysis showed that the factors associated with poor disease-free survival were: age < 35 years (P = 0.001), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P<0.001), 20 or more positive lymph nodes (P<0.001), presence of lymphovascular invasion (P = 0.003), and negative progesterone receptor expression (P = 0.003). Multivariate analysis showed the factors with independent prognostic significance to be: history of neoadjuvant chemotherapy (hazard ratio [HR] 3.163; 95% confidence interval [CI], 2.025-4.941; P<0.001), 20 or more positive nodes (HR 1.598; 95% CI, 1.063-2.402; P = 0.024), and presence of lymphovascular invasion (HR 1.636; 95% CI, 1.009-2.654; P = 0.046). Factors associated with poor overall survival in univariate analysis were: age <35 years (P = 0.033), history of neoadjuvant chemotherapy (P<0.001), T4 stage (P = 0.001), 20 or more positive lymph nodes (P<0.001), and negative progesterone receptor expression (P = 0.013). Multivariate analysis showed these factors to be: history of neoadjuvant chemotherapy (HR 2.900; 95% CI, 2.011-4.182; P<0.001), and 20 or more positive nodes (HR 1.956; 95% CI, 1.419-2.696; P<0.001). Conclusion: Cases of breast tumors with extensive nodal metastasis were found to be heterogeneous in terms of prognosis. History of previous neoadjuvant chemotherapy and higher numbers of metastatic lymph nodes were found to be the two most important prognostic markers for pathologic N3a disease. New strategies such as biologic therapy and novel combinations should be considered for application in patients with poor prognosis, rather than conventional treatment.

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DO - 10.1007/s10147-011-0207-5

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