[Clinical characteristics and prognostic factors of female breast cancer patients with 10 or more positive lymph nodes: a report of 128 patients]

Yin Guan, Bing-He Xu, Qing Li, Pin Zhang, Long-Mei Zhao, Peng Yuan, Jia-Yu Wang
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2008 January 8, 88 (2): 77-81

OBJECTIVE: To analyze the clinical characteristics, survival, and prognosis of female breast cancer patients with 10 or more positive lymph nodes.

METHODS: The data of 128 female breast cancer patients with 10 or more positive lymph nodes from JAN 1998 to Mar 2002 were retrospectively reviewed. The clinical characteristics, survival, and prognostic factors were analyzed by SPSS 10.0 statistic software.

RESULTS: The 1-, 3-, 5, and 7-year overall survival (OS) rates were 91.4%, 68.8%, 53.1%, and 40.2%, and the disease free survival (DFS) rates were 80.9%, 54.1%, 44.7%, and 36.0% respectively. Log Rank test showed that tumor size was not related to prognosis; patients with more than 20 positive lymph nodes (P = 0.029), positive lymph node ratio greater than 0.8 (P = 0.027), and infiltration of vessel (P = 0.037) had a poorer DFS and shorter OS; patients with negative hormonal receptor had a poorer OS than those with positive hormonal receptor (P = 0.019); radiotherapy improved DFS (P = 0.000), and adjuvant chemotherapy for 4 - 6 cycles (P = 0.000) or more than 6 cycles (P = 0.004) and endocrine therapy (P = 0.001) might improve DFS and OS; patients with multiple metastasis had a poorer survival than those with local recurrence (P = 0.004) and single metastasis (P = 0.058). COX proportional hazard model analysis showed that positive lymph node ratio and infiltration of vessel were independent prognostic factors for both DFS and OS; adjuvant endocrine therapy decreased relapse and death hazard ratio for 43% (RR = 0.57, P = 0.035) and 65% (RR = 0.35, P = 0.000) respectively; adjuvant radiotherapy decreased the relapse hazard ratio for 72% (RR = 0.28, P = 0.000); and adjuvant chemotherapy for more than 4 cycles decreased death hazard ratio for 51% (RR = 0.49, P = 0.001); patients with recurrence and/or metastasis had a higher death hazard ratio (RR = 2.738, P = 0.000), hormonal receptor was an independent prognostic factor, and active treatment might improve the survival.

CONCLUSION: Breast cancers with 10 or more positive lymph nodes have higher aggressively biologic characteristics; the prognosis of this subgroup has no relationship with tumor size and inverse correlation with the numbers of positive lymph nodes; Positive lymph node ratio and infiltration of vessel are important independent factors. Multidiscipline therapy including adjuvant radiotherapy, endocrine therapy, and at least 4 cycles chemotherapy increases the therapeutic effect, decreases relapse and death hazard ratio, and improves the survival.

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