<p>Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database</p>

Abstract

Background: Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated. Material and Methods: Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes. Results: In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001). Conclusion: Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.

Lymph Node Ratio as a Good Prognostic Factor for Patients with Pathologic N3a Breast Cancer with 10 or More Metastatic Axillary Lymph Nodes

“…In the present study, the 5-year DFS and OS rates after surgery followed by adjuvant treatment were 63.0% and 85.9%, respectively. These values are comparable to the results reported in previous studies on the survival rate of patients with N3a breast cancer [13][14][15].…”

“…tend to select NAC as the initial treatment for patients with suspicious metastatic supraclavicular or internal mammary lymph nodes, or even multiple level III axillary lymph nodes [12,13]. NAC might have the benefit of downstaging not only the size of the primary tumor but also the tumor burden of the lymph nodes.…”

Real-World Study: A Powerful Tool for Malignant Tumor Research in General Surgery

“…Recently, a single-agency RWS found that there was still a difference in prognosis among N3a, N3b and N3c. N3c patients had the worst clinical prognosis, while N3b patients had a better prognosis than N3a patients [ 41 ]. A retrospective RWS found that changes in Ki67 can help predict the prognosis of patients with luminal type B BC, providing a measurement of neoadjuvant chemotherapy efficacy and assisting in further clinical decisions [ 42 ].…”

Nontherapeutic Risk Factors of Different Grouped Stage IIIC Breast Cancer Patients’ Mortality: A Study of the US Surveillance, Epidemiology, and End Results Database

“…The 5-year overall survival (OS) and 5-year disease-specific survival (DSS) of stage IIIC breast cancer are about 61.7% and 66.8%, respectively, and its prognosis is relatively worse than that of early breast cancer [ 5 ]. Some studies have discussed the prognostic indicators of stage IIIC breast cancer, such as molecular typing and lymph node ratio (LNR).…”