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


Background: Axillary lymph node status at diagnosis remains the strongest predictor of long-term survivalin 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 ofmultimodality therapy. Materials and
Methods: In this retrospective study, we looked at all breast cancer patientswith greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysisfor time-to-event data, using the extended Cox regression model was carried out.
Results: With a median andmean 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- andten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significantimprovement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among youngpatients (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 asignificantly improved DFS compared with white patients. Young age and ER tumor positivity was associatedwith improved outcomes. Using multivariate analysis, there were no other variables associated with statisticallysignificant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breastcancer survival in this subgroup of patients.