Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Long-Term Survival of Women with Locally Advanced Breast Cancer with ≥10 Involved Lymph Nodes at Diagnosis

  • Published : 2014.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: 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. 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). 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. Results: 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). Conclusions: 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.

Keywords

References

  1. Akhsan A, Aryandono T (2010). Prognostic factors of locally advanced breast cancer patients receiving neoadjuvant and adjuvant chemotherapy. Asian Pac J Cancer Prev. 11, 759-61.
  2. Ambrosini G, Balli M, Garusi G, et al (1988). Phase III randomized study of fluorouracil, epirubicin, and cyclophosphamide fluorouracil, doxorubicin, and cyclophosphamide in advanced breast cancer: an Italian multicentre trial. Italian Multicentre Breast Study with Epirubicin. J Clin Oncol, 6, 976-82.
  3. Anaya-Ruiz M, Vallejo-Ruiz V, Flores-Mendoza L, Perez-Santos M (2014). Female breast cancer incidence and mortality in Mexico, 2000-2010. Asian Pac J Cancer Prev, 15, 1477-9. https://doi.org/10.7314/APJCP.2014.15.3.1477
  4. Anders CK, Hsu DS, Broadwater G, et al (2008). Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 26, 3324-30. https://doi.org/10.1200/JCO.2007.14.2471
  5. Balakrishnan N, Rao CR (2002). Race, socioeconomic status, and breast cancer treatment and survival. Elsevier Science B.V.
  6. Banegas MP, Li CI (2012). Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women. Breast Cancer Res Treat, 134, 1297-304. https://doi.org/10.1007/s10549-012-2142-1
  7. Basaran G, Devrim C, Caglar HB, et al (2011). Clinical outcome of breast cancer patients with N3a (${\geq}$10 positive lymph nodes) disease: has it changed over years? Med Oncol, 28, 726-32. https://doi.org/10.1007/s12032-010-9516-1
  8. Blue L, Fenelon A. (2011). Explaining low mortality among US immigrants relative to native-born Americans: the role of smoking. Int J Epidemiol, 40, 786-93. https://doi.org/10.1093/ije/dyr011
  9. Buzdar AU, Kau SW, Hortobagyi GN, et al (1992). Clinical course of patients with breast cancer with ten or more positive nodes who were treated with doxorubicin-containing adjuvant therapy. Cancer, 69, 448-52. https://doi.org/10.1002/1097-0142(19920115)69:2<448::AID-CNCR2820690229>3.0.CO;2-K
  10. Buzdar A, Jonat W, Howell A, et al (1996). Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal women with advanced breast cancer: results of overview analysis of two phase III trials. Arimidex Study Group. J Clin Oncol, 14, 2000-11.
  11. Carey LA, Perou CM, Livasy CA, et al (2006). Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA, 295, 2492. https://doi.org/10.1001/jama.295.21.2492
  12. Colleoni M, Rotmensz N, Peruzzotti G, et al (2005). Size of breast cancer metastases in axillary lymph nodes: clinical relevance ofminimal lymph node involvement. J Clin Oncol, 23, 1379-89 https://doi.org/10.1200/JCO.2005.07.094
  13. Danko ME, Bennett KM, Zhai J, Marks JR, Olson JA Jr (2010) Improved staging in node-positive breast cancer patients using lymph node ratio: results in 1,788 patients with longterm follow-up. J Am Coll Surg, 210, 797-805. https://doi.org/10.1016/j.jamcollsurg.2010.02.045
  14. Duman BB, Afsar CU, GUnaldi M, et al (2012). Retrospective analysis of neoadjuvant chemotherapy for breast cancer in Turkish patients. Asian Pac J Cancer Prev, 13, 4119-23. https://doi.org/10.7314/APJCP.2012.13.8.4119
  15. Edge S, Byrd D, Compton C, et al (2010). American Joint Committee on Cancer. AJCC Cancer Staging Manual, 7th ed.
  16. Fan C, Oh DS, Wessels L, et al (2006). Concordance among gene-expression-based predictors for breast cancer. N Engl J Med, 355, 560. https://doi.org/10.1056/NEJMoa052933
  17. Giordano SH (2003). Update on locally advanced breast cancer. Oncologist, 8, 521-30. https://doi.org/10.1634/theoncologist.8-6-521
  18. Han SJ, Guo QQ, Wang T, et al (2013). Prognostic significance of interactions between ER alpha and ER beta and lymph node status in breast cancer cases. Asian Pac J Cancer Prev, 14, 6081-4. https://doi.org/10.7314/APJCP.2013.14.10.6081
  19. Howlader N, Noone AM, Krapcho M, et al (2012).SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, SEER data submission, posted to the SEER web site, 2012.
  20. Hu Z, Fan C, Oh DS, et al (2006) The molecular portraits of breast tumors are conserved across microarray platforms. BMC Genomics, 7, 96. https://doi.org/10.1186/1471-2164-7-96
  21. Keramatinia A, Mousavi-Jarrahi SH, Hiteh M, Mosavi-Jarrahi A (2014). Trends in incidence of breast cancer among women under 40 in Asia. Asian Pac J Cancer Prev, 15, 1387-90. https://doi.org/10.7314/APJCP.2014.15.3.1387
  22. Koca E, Kuzan TY, Dizdar O, et al (2013). Outcomes of locally advanced breast cancer patients with ${\geq}$10 positive axillary lymph nodes. Med Oncol, 30, 615. https://doi.org/10.1007/s12032-013-0615-7
  23. Lee JS, Kim SI, Choi SY, et al (2011). Factors influencing the outcome of breast cancer patients with 10 or more metastasized axillary lymph nodes. Int J Clin Oncol, 16, 473-81. https://doi.org/10.1007/s10147-011-0207-5
  24. Livaudais JC, Hershman DL, Habel L, et al (2012). Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. Breast Cancer Res Treat, 131, 607-17. https://doi.org/10.1007/s10549-011-1762-1
  25. Livi L, Meattini I, Saieva C, et al (2012). Prognostic value of positive human epidermal growth factor receptor 2 status and negative hormone status in patients with T1a/T1b, lymph node-negative breast cancer. Cancer, 118, 3236-43. https://doi.org/10.1002/cncr.26647
  26. Mieog JS, van der Hage JA, van de Velde CJ. (2007). Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev.
  27. Montero AJ, Rouzier R, Lluch A, et al (2005). The natural history of breast carcinoma in patients with > or=10 metastatic axillary lymph nodes before and after the advent of adjuvant therapy: a multiinstitutional retrospective study. Cancer, 104, 229-35. https://doi.org/10.1002/cncr.21182
  28. Nabholtz JM, Mackey JR, Smylie M, et al (2001). Phase II study of docetaxel, doxorubicin, and cyclophosphamide as first-linechemotherapy for metastatic breast cancer. J Clin Oncol, 19, 314-21
  29. Palmer JR, Wise LA, Horton NJ, Adams-Campbell LL, Rosenberg L (2003). Dual effect of parity on breast cancer risk in African-American women. J Natl Cancer Inst, 95, 478. https://doi.org/10.1093/jnci/95.6.478
  30. Parker JS, Mullins M, Cheang MC, et al (2009). Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol, 27, 1160. https://doi.org/10.1200/JCO.2008.18.1370
  31. Prajoko YW(1), Aryandono T (2014). Expression of nuclear factor kappa B (NF-$\kappa$B) as a predictor of poor pathologic response to chemotherapy in patients with locally advanced breast cancer. Asian Pac J Cancer Prev, 15, 595-8. https://doi.org/10.7314/APJCP.2014.15.2.595
  32. Ragaz J, Jackson SM, Le N, et al (1997). Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med, 337, 956-62. https://doi.org/10.1056/NEJM199710023371402
  33. Rezaianzadeh A, Talei A, Rajaeefard A et al (2012). Vascular invasion as an independent prognostic factor in lymph node negative invasive breast cancer. Asian Pac J Cancer Prev, 13, 5767-72 https://doi.org/10.7314/APJCP.2012.13.11.5767
  34. Ries LAG, Eisner MP and Kosary CL. (2001). SEER Cancer Statistics Review, 1973-1998, National Cancer Institute.
  35. Robertson FM, Bondy M, Yang W, et al (2010). Inflammatory breast cancer: the disease, the biology, the treatment. CA Cancer J Clin, 60, 351-75 https://doi.org/10.3322/caac.20082
  36. Schmoor C, Sauerbrei W, Bastert G, Bojar H, Schumacher M (2001). Long-term prognosis of breast cancer patients with 10 or more positive lymph nodes treated with CMF. Eur J Cancer, 37, 1123-31. https://doi.org/10.1016/S0959-8049(01)00090-9
  37. Suciu, GP, Lemeshow S, Moeschberger M (2004). Statistical Test of Equality of Survival Curves: Reconsidering the Options, Handbook of Statistics, Vol.23, Chapter 13. Eds.
  38. Turra CM, Elo IT (2008). The Impact of Salmon Bias on the Hispanic Mortality Advantage: New Evidence from Social Security Data. Popul Res Policy Rev, 27, 515-30. https://doi.org/10.1007/s11113-008-9087-4
  39. VanderWalde A, Ye W, Frankel P, et al (2012). Long-term survival after high-dose chemotherapy followed by peripheral stem cell rescue for high-risk, locally advanced/inflammatory, and metastatic breast cancer. Biol Blood Marrow Transplant, 18, 1273-80. https://doi.org/10.1016/j.bbmt.2012.01.021
  40. Vinh-Hung V, Verschraegen C, Promish DI, et al (2004) Ratios of involved nodes in early breast cancer. Breast Cancer Res, 6, 680-8. https://doi.org/10.1186/bcr934
  41. Voduc KD, Cheang MC, Tyldesley S, et al (2010). Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol, 28, 1684. https://doi.org/10.1200/JCO.2009.24.9284
  42. Woodward WA, Strom EA, Tucker SL, et al (2003) Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol, 21, 3244-8 https://doi.org/10.1200/JCO.2003.03.052
  43. Woodward WA, Huang EH, McNeese MD, et al (2006).African-American race is associated with a poorer overall survival rate for breast cancer patients treated with mastectomy and doxorubicin-based chemotherapy. Cancer, 107, 2662-8. https://doi.org/10.1002/cncr.22281
  44. Woodward WA, Vinh-Hung V, Ueno NT, et al (2006) Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol, 24, 2910-6. https://doi.org/10.1200/JCO.2005.03.1526
  45. Zeichner SB, Zeichner SB, Ruiz AL, Markward NJ, Rodriguez E (2014). Improved long-term survival with contralateral prophylactic mastectomy among young women. Asian Pac J Cancer Prev, 15, 1155-62. https://doi.org/10.7314/APJCP.2014.15.3.1155

Cited by

  1. Fitting Cure Rate Model to Breast Cancer Data of Cancer Research Center vol.16, pp.17, 2015, https://doi.org/10.7314/APJCP.2015.16.17.7923
  2. Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors vol.11, pp.5, 2016, https://doi.org/10.3892/ol.2016.4349