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Abstract
Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival. In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy. In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and 5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysis for time-to-event data, using the extended Cox regression model was carried out. With a median and mean follow-up of 70 and 89.9 months, respectively, the overall median survival was estimated to be 99 months. The five-year disease-free survival (DFS) was 59.3% and the ten-year DFS was 37.9%, whereas the five- and ten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significant improvement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among young patients (ages 21-45) compared to elderly patients (age greater than 70) (p=0.00176, p=0.0034, respectively), and improved DFS and OS among patients whose tumors were ER positive (p=0.049, p=0.0034). In this single institution study of patients with greater than 10 positive axillary nodes, black patients had a significantly improved DFS compared with white patients. Young age and ER tumor positivity was associated with improved outcomes. Using multivariate analysis, there were no other variables associated with statistically significant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breast cancer survival in this subgroup of patients.
Highlights
With an estimated 226,870 diagnoses and 39,510 deaths in 2012, breast cancer remains the most commonly occurring and second most lethal cancer among women in the United States (Howlader et al, 2012)
Materials and Methods: In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161)
We looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161), with a follow-up until December 31st 2012
Summary
With an estimated 226,870 diagnoses and 39,510 deaths in 2012, breast cancer remains the most commonly occurring and second most lethal cancer among women in the United States (Howlader et al, 2012). In patients with LABC, the rate of recurrence and associated disease related mortality is high, with an estimated 10-year overall survival (OS) between 24-50% (Woodward et al, 2003; Montero et al, 2005), with inflammatory breast cancer (IBC) having the worst prognosis (Edge et al, 2010, Robertson et al, 2010). We set out to look at our own single institutional experience among breast cancer patients with greater than ten axillary lymph nodes at diagnosis. Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy. Further work is needed to improve breast cancer survival in this subgroup of patients
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