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

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.