Authors: Emre Koca Taha Y Kuzan Omer Dizdar Taner Babacan Ilyas Sahin Erhan Ararat Kadri Altundag
Publish Date: 2013/06/01
Volume: 30, Issue: 3, Pages: 615-
Abstract
Breast cancers with 10 or more positive lymph nodes at the time of diagnosis are staged as pathological N3a pN3a and they have poor prognosis Recent studies showed fiveyear diseasefree survival DFS and overall survival OS rates of N3a disease as 43–66 and 58–81 respectively We herein present outcomes of our patients with stage pN3a breast cancer Among 2578 patients diagnosed with invasive breast carcinoma at Hacettepe University Hospital between 2002 and 2012 218 patients 84 had pN3a disease and were included and analyzed retrospectively in this study Patients with internal mammary infraclavicular and supraclavicular node metastasis or distant metastasis at initial diagnosis were excluded Demographic features tumor characteristics treatment regimens and patient outcomes in terms of DFS and OS were analyzed Lymph node ratio was defined as the ratio of positive to total removed lymph nodes The median age was 49 Most common histological subtype was ductal carcinoma 821 About 826 of patients had stage T2/T3 cancers and 477 104 had grade III cancers Estrogen and progesterone receptors were positive in 133 61 and 121 555 patients respectively HER2 status was known for 213 patients and was positive in 87 399 patients A total of 27 126 patients had triplenegative tumors Lymphovascular invasion extracapsular extension and perineural invasion were present in 106 486 105 482 20 92 cases respectively A total of 18 patients 83 received neoadjuvant and 200 patients 917 received adjuvant chemotherapy mostly with anthracycline 95 and taxane 60 containing regimens A total of 210 patients 963 received radiotherapy Median followup was 395 months A total of 96 patients relapsed on followup and 64 patients died Nineteen of the relapses were locoregional and 77 were distant relapses The 5year DFS rate was 462 and the OS rate was 698 In multivariate Cox regression analysis grade III disease HR 1899 95 CI 1196–3017 P = 0007 perineural invasion HR 2519 95 CI 1341–4731 P = 0004 and lymph node ratio ≥09 vs 09 HR 2290 95 CI 1368–3835 P = 0002 were significantly associated with DFS and grade III disease HR 2679 95 CI 1500–4782 P = 0001 and lymph node ratio ≥09 vs 09 HR 2182 95 CI 1211–3932 P = 0009 were significantly associated with OS Patients with pN3a disease in our cohort have comparable survival rates with other reports in the literature Within this high risk group of patients those with grade III disease perineural invasion and lymph node ratio ≥09 seem to confer poorer prognosis
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