Clinical outcome of breast cancer patients with N3a (≥10 positive lymph nodes) disease: has it changed over years?

Abstract

It has been shown that breast cancer patients with N3a (10 positive lymph nodes) had a poor prognosis. We planned to investigate the clinical outcome BC patients who presented with N3a disease and had no evidence of systemic metastasis at the time of diagnosis. We made a retrospective chart review of breast cancer patients who had ≥10 positive lymph nodes and received adjuvant systemic therapy in Marmara University Hospital between 1998 and 2008. We recorded clinical, pathologic and treatment characteristics of the patients and analyzed the survival outcome. We identified 73 patients with N3a disease who were treated in Marmara University Hospital between 1998 and 2008. The median age was 52. Most (75%) of the patients had invasive ductal histology, 75% had T2/T3 tumors, 36% had grade 3 tumors. The median number of metastatic lymph nodes was 15. Estrogen and progesterone receptors were both positive in 61% and both negative in 16+ tumors. Her-2/neu status was assessed in 68% of the tumors; 18% of patients had 3+ and 50% had negative scores. Six patients had triple negative tumors. All patients except one received adjuvant chemotherapy and radiotherapy. Seventy-four percent of patients received anthracycline/taxane-based chemotherapy. Fifty-nine patients received adjuvant endocrine therapy, 42% them received aromatase inhibitors. Five of the 13 Her-2 positive patients received adjuvant trastuzumab. With a median follow-up of 47 months, 5-year disease and overall survival rates were 66 and 81%, respectively. Twenty-four patients had relapsed and 14 patients died. Her-2 status and the number of lymph nodes (<20 vs. ≥20) had significant impact on disease-free survival in the univariate analysis (P=0.03 and 0.05, respectively) and Her-2 retained its significant impact on disease-free survival in the multivariate analysis (P=0.05). The prognosis of BC patients with N3a disease has changed favorably in the past decade with the current standards of care.

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

“…There are some controversies on the prognostic value of T stage in pN3a disease. Some authors have reported that there are prognostically different subgroups in pN3a disease by T stage [8,9], while other studies did not show the prognostic value of T stage [5,10,13,14]. In our study, pN3a patients with T4 tumors had significantly worse DFS and OS compared to those with a T1-3 tumor in univariate analysis, but failed to show statistical significance in the multivariate analysis.…”

“…Another study reported that the 5-year survival rates for patients with 11-15, 16-20, and 21 or more positive nodes were 55, 49 and 38%, respectively [16]. In addition, many studies have suggested that the number of positive lymph nodes is the strongest prognostic factor in patients with pN3a disease [5,10,11].…”

“…Nearly three decades later, in the most recent report, however, the 5-year-DFS and OS of these extremely high risk patients were reported to have increased to 66 and 81% respectively, with the use of effective chemotherapeutic agents, molecularly targeted agents (e.g. trastuzumab), and optimal use of endocrine therapy [5]. In the sixth edition of the American Joint Committee on Cancer (AJCC) TMN staging system, the N classification was newly defined by the number of affected axillary lymph nodes.…”

Long-Term Survival of Women with Locally Advanced Breast Cancer with ≥10 Involved Lymph Nodes at Diagnosis

“…Our study produced long-term DFS (5-year: 59.3%; *Event-free survival; ** Estimated 10-year: 37.9%) and OS (5-year: 66.6%; 10-year: 43.9%) similar to other cohorts analyzed over the past decade, which produced a 5-year DFS ranging from 42.9-66% and a 5-year OS ranging from 57-81% (Table 5, Schmoor et al, 2001;Basaran et al, 2011;Lee et al, 2011). This is in stark contrast to earlier cohorts that saw 5-and 10-year OS survival rates of 39% and 24%, respectively (Buzdar et al, 1992;Walker et al, 1995).…”

Prognostic Factors in Operated Stage IIIC, Pathological N3a Breast Cancer Patients

“…These patients constitute only a small subset of the study population in large-scale prospective BC trials [6]. Retrospective studies usually have nonhomogeneous patient populations [7,8,9,10]. A recent study noted that, unlike early recurrence, the tumor biology may have a more important role than the tumor load (positive lymph nodes) for late recurrence in ER-positive disease [11,12].…”