Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Abstract

Introduction: Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on diseasespecific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria. Methods: We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes-distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method. Results: Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 + 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%. Conclusion: Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.

Pattern of survival of breast cancer patients in a tertiary hospital in south west Nigeria

“…Most patients (98.9%) had a tumour ≥2 cm while 28.0% had tumours >5 cm. This is similar to what was reported by Ayandipo et al [ 19 ] in Ibadan, 93.3% of their patients had tumours ≥2 cm and 65.3% >5 cm in size. There are disparities in the size of the tumour at presentation in this study with that of the western world.…”

“…The study found the mean age of breast cancer patients to be 47.6 years (SD 11.2) which is consistent with the findings of Adesunkanmi et al [ 18 ] in Ile-ife and studies in Ibadan by Dairo et al [ 9 ] and Ayandipo et al [ 19 ]. Similar findings were also demonstrated from north eastern part of Nigeria at the University of Maiduguri Teaching Hospital [ 20 ] and Federal Medical Centre, Gombe [ 21 ].…”

“…A study assessing the 'Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria' reported an overall 5-year survival rate of 65.3% [19] which is higher than in our study probably because it is prospective and are able to follow up the patients easily, but this is still low when compared to the Western World data.…”

“…A large number of the patients were employed (85.4%), this is in contrast to a study in Ibadan which found a lower rate of employment at 44.4% [25], but other studies in Ibadan and Ile-ife found a similar high employment rate [18,19].…”

“…In a study in Ibadan clinic—pathologic parameters like large tumour size, invasive ductal carcinoma, grade, positive resection margin, number of harvested nodes, number of positive metastatic nodes and presence of loco-regional recurrence were associated with poor survival [ 19 ]. This further affirms the fact that the negative impact of traditional prognostic factors such as large tumour size, stage, palpable nodes and presence of metastasis on survival as reported in our study.…”