Long-term survival and prognostic factors in patients with regional breast cancer (skin, muscle, and/or chest wall attachment).

Between 1948 and 1981, 1230 patients were diagnosed as having regional (skin, muscle, or chest wall attachment) breast cancer, and long-term survival was studied. In all patients, overall survival was 33% at 5 years, 19% at 10 years, and 9% at 20 years. Significant excess mortality due to breast cancer was observed throughout the 20-year follow-up period (P less than 0.002). The risk of breast cancer was highest in the 5-year period following diagnosis, and declined steadily from that time. Additionally, 308 patients diagnosed since 1968 were studied for the effect of prognostic factors. Clinical status of nodes (positive or negative) and presence or absence of peau d'orange were found to be significant prognostic factors in those patients. In those receiving radical surgery, the number of nodes and presence or absence of peau d'orange were found to be of prognostic significance. No effect of race, age, year of diagnosis, site of attachment, type of fixation, ulceration, edema, size of tumor, satellite nodules, or dimpling retraction on breast-cancer-specific survival was observed when the nodal status and peau d'orange were controlled. These data demonstrate that mortality in regional breast cancer is significant and is highly dependent on peau d'orange and nodal status.