Marmara University Hospital, Istanbul, Turkey.
Med Oncol. 2011 Sep;28(3):726-32. doi: 10.1007/s12032-010-9516-1.
It has been shown that breast cancer patients with N3a (10 positive lymph nodes) had a poor prognosis. We planned to investigate the clinical outcome BC patients who presented with N3a disease and had no evidence of systemic metastasis at the time of diagnosis. We made a retrospective chart review of breast cancer patients who had ≥10 positive lymph nodes and received adjuvant systemic therapy in Marmara University Hospital between 1998 and 2008. We recorded clinical, pathologic and treatment characteristics of the patients and analyzed the survival outcome. We identified 73 patients with N3a disease who were treated in Marmara University Hospital between 1998 and 2008. The median age was 52. Most (75%) of the patients had invasive ductal histology, 75% had T2/T3 tumors, 36% had grade 3 tumors. The median number of metastatic lymph nodes was 15. Estrogen and progesterone receptors were both positive in 61% and both negative in 16+ tumors. Her-2/neu status was assessed in 68% of the tumors; 18% of patients had 3+ and 50% had negative scores. Six patients had triple negative tumors. All patients except one received adjuvant chemotherapy and radiotherapy. Seventy-four percent of patients received anthracycline/taxane-based chemotherapy. Fifty-nine patients received adjuvant endocrine therapy, 42% them received aromatase inhibitors. Five of the 13 Her-2 positive patients received adjuvant trastuzumab. With a median follow-up of 47 months, 5-year disease and overall survival rates were 66 and 81%, respectively. Twenty-four patients had relapsed and 14 patients died. Her-2 status and the number of lymph nodes (<20 vs. ≥20) had significant impact on disease-free survival in the univariate analysis (P=0.03 and 0.05, respectively) and Her-2 retained its significant impact on disease-free survival in the multivariate analysis (P=0.05). The prognosis of BC patients with N3a disease has changed favorably in the past decade with the current standards of care.
已经表明，N3a（10 个阳性淋巴结）的乳腺癌患者预后不良。我们计划研究在诊断时无全身转移证据但存在 N3a 疾病的乳腺癌患者的临床结局。我们对 1998 年至 2008 年期间在马尔马拉大学医院接受≥10 个阳性淋巴结且接受辅助全身治疗的乳腺癌患者进行了回顾性图表审查。我们记录了患者的临床、病理和治疗特征，并分析了生存结果。我们确定了 1998 年至 2008 年期间在马尔马拉大学医院治疗的 73 例 N3a 疾病患者。中位年龄为 52 岁。大多数（75%）患者为浸润性导管组织学，75%的患者为 T2/T3 肿瘤，36%的患者为 3 级肿瘤。转移淋巴结的中位数为 15 个。雌激素和孕激素受体均阳性者占 61%，均阴性者占 16%+。68%的肿瘤评估了 Her-2/neu 状态；18%的患者为 3+，50%为阴性评分。6 例患者为三阴性肿瘤。除 1 例患者外，所有患者均接受了辅助化疗和放疗。74%的患者接受了蒽环类/紫杉类药物为基础的化疗。59 例患者接受了辅助内分泌治疗，其中 42%接受了芳香酶抑制剂治疗。13 例 Her-2 阳性患者中有 5 例接受了辅助曲妥珠单抗治疗。中位随访 47 个月后，5 年疾病无进展生存率和总生存率分别为 66%和 81%。24 例患者复发，14 例患者死亡。在单因素分析中，Her-2 状态和淋巴结数量（<20 vs. ≥20）对无病生存率有显著影响（P=0.03 和 0.05），而 Her-2 在多因素分析中仍然对无病生存率有显著影响（P=0.05）。随着目前的治疗标准，过去十年中 N3a 疾病乳腺癌患者的预后已经有所改善。
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