Abstract
IntroductionOncologic 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 disease-specific 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.MethodsWe 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.ResultsSixty (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%.ConclusionUnfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.
Highlights
Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance
While surgical extirpation continues to be the mainstay of loco-regional disease control by achieving negative margins and lymph node clearance, it is well documented that the nodal status at diagnosis significantly affects overall survival, with axillary lymph nodal metastasis being a critical index of prognostication [9,10,11]
Lymph node ratio (LNR), defined as the proportion of harvested lymph nodes positive for malignancy to total resected nodes [12, 13], has been implicated as a key prognostic factor
Summary
The mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. The findings from an Ibadan population-based cancer registry in 2012 showed an incidence rate of 52.0 per 100,000 [3] They are typically late stage, high grade and hormone receptor negative, and these factors represent an aggressive phenotype [4, 5]. While surgical extirpation continues to be the mainstay of loco-regional disease control by achieving negative margins and lymph node clearance, it is well documented that the nodal status at diagnosis significantly affects overall survival, with axillary lymph nodal metastasis being a critical index of prognostication [9,10,11]. An intensive multimodal approach to breast cancer care is key to achieving longer disease-free survival and overall survival times [10, 11]
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