Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Int J Clin Oncol. 2011 Oct;16(5):473-81. doi: 10.1007/s10147-011-0207-5. Epub 2011 Mar 1.
The purpose of this study was to investigate prognostic factors in breast cancer patients with metastasis of ten or more lymph nodes (pathologic N3a).
We conducted a retrospective analysis of the cases of 304 breast cancer patients with pathologic N3a disease who had undergone definitive surgery between 1986 and 2006, and investigated the correlation between clinicopathologic characteristics and treatment outcomes.
With a median follow-up period of 55 months, the 5-year disease-free survival rate was 42.9% and the overall survival rate was 57.8%. Univariate analysis showed that the factors associated with poor disease-free survival were: age < 35 years (P = 0.001), history of neoadjuvant chemotherapy (P < 0.001), T4 stage (P < 0.001), 20 or more positive lymph nodes (P < 0.001), presence of lymphovascular invasion (P = 0.003), and negative progesterone receptor expression (P = 0.003). Multivariate analysis showed the factors with independent prognostic significance to be: history of neoadjuvant chemotherapy (hazard ratio [HR] 3.163; 95% confidence interval [CI], 2.025-4.941; P < 0.001), 20 or more positive nodes (HR 1.598; 95% CI, 1.063-2.402; P = 0.024), and presence of lymphovascular invasion (HR 1.636; 95% CI, 1.009-2.654; P = 0.046). Factors associated with poor overall survival in univariate analysis were: age < 35 years (P = 0.033), history of neoadjuvant chemotherapy (P < 0.001), T4 stage (P = 0.001), 20 or more positive lymph nodes (P < 0.001), and negative progesterone receptor expression (P = 0.013). Multivariate analysis showed these factors to be: history of neoadjuvant chemotherapy (HR 2.900; 95% CI, 2.011-4.182; P < 0.001), and 20 or more positive nodes (HR 1.956; 95% CI, 1.419-2.696; P < 0.001).
Cases of breast tumors with extensive nodal metastasis were found to be heterogeneous in terms of prognosis. History of previous neoadjuvant chemotherapy and higher numbers of metastatic lymph nodes were found to be the two most important prognostic markers for pathologic N3a disease. New strategies such as biologic therapy and novel combinations should be considered for application in patients with poor prognosis, rather than conventional treatment.
本研究旨在探讨转移淋巴结 10 个及以上（病理 N3a）的乳腺癌患者的预后因素。
我们对 1986 年至 2006 年间接受确定性手术的 304 例病理 N3a 疾病的乳腺癌患者进行了回顾性分析，并探讨了临床病理特征与治疗结果之间的相关性。
中位随访时间为 55 个月，5 年无病生存率为 42.9%，总生存率为 57.8%。单因素分析显示，与无病生存不良相关的因素有：年龄<35 岁（P=0.001）、新辅助化疗史（P<0.001）、T4 期（P<0.001）、20 个及以上阳性淋巴结（P<0.001）、存在脉管侵犯（P=0.003）和孕激素受体阴性表达（P=0.003）。多因素分析显示，具有独立预后意义的因素有：新辅助化疗史（风险比[HR]3.163；95%置信区间[CI]2.025-4.941；P<0.001）、20 个及以上阳性淋巴结（HR 1.598；95%CI，1.063-2.402；P=0.024）和脉管侵犯（HR 1.636；95%CI，1.009-2.654；P=0.046）。单因素分析中与总生存不良相关的因素有：年龄<35 岁（P=0.033）、新辅助化疗史（P<0.001）、T4 期（P=0.001）、20 个及以上阳性淋巴结（P<0.001）和孕激素受体阴性表达（P=0.013）。多因素分析显示，这些因素为：新辅助化疗史（HR 2.900；95%CI，2.011-4.182；P<0.001）和 20 个及以上阳性淋巴结（HR 1.956；95%CI，1.419-2.696；P<0.001）。
发现具有广泛淋巴结转移的乳腺癌肿瘤在预后方面存在异质性。先前新辅助化疗史和更多的转移淋巴结数目是病理 N3a 疾病最重要的两个预后标志物。对于预后不良的患者，应考虑采用生物治疗和新的联合治疗等新策略，而不是常规治疗。
