J Breast Cancer.  2016 Jun;19(2):163-168. 10.4048/jbc.2016.19.2.163.

Prognostically Distinctive Subgroup in Pathologic N3 Breast Cancer

• Kim YY
• Park HK
• Lee KH
• Kim KI
• Chun YS

• KMID: 2308967
• DOI: http://doi.org/10.4048/jbc.2016.19.2.163

Abstract

PURPOSE
The aim of this retrospective study was to investigate whether there are prognostically different subgroups among patients with pathologic N3 (pN3) breast cancer.
METHODS
The records of 220 patients who underwent surgery for pN3 breast cancer from January 2006 to September 2012 were reviewed. All patients received adjuvant therapy according to standard protocols. The primary outcome was disease-free survival (DFS).
RESULTS
Patients were followed for a median time of 68.3 months after their primary surgery (range, 10-122 months), during which time 75 patients (34.1%) had developed disease recurrence and 48 patients (21.8%) had died. The DFS and overall survival were 67.8% and 86.1%, respectively, at 5 years. Multiple logistic regression analysis showed that young age (<35 years, p=0.009), high serum neutrophil/lymphocyte ratio (>3.0) (p=0.020), high nodal ratio (number of metastatic lymph nodes divided by number of removed nodes) (>0.65) (p=0.062), and molecular phenotype (p=0.012) were significantly associated with tumor recurrence. Tumor biological subtype was the most significant predictor of recurrence. The 5-year DFS rates in patients with hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER2) negative, HR+HER2+, HR-HER2+, and triple negative subtypes were 82%, 63%, 58%, and 37%, respectively.
CONCLUSION
Clinical outcomes of patients with extensive nodal metastasis were heterogeneous in terms of prognosis. Tumor biological subtype was the most important prognostic factor for pN3 disease. The prognosis of patients with HR+HER2- subtype in pN3 breast cancer was similar to that of patients with stage II breast cancer.

Keyword

Biology; Breast neoplasms; Neoplasm staging; Prognosis

MeSH Terms

Biology
Breast Neoplasms*
Breast*
Disease-Free Survival
Humans
Logistic Models
Lymph Nodes
Neoplasm Metastasis
Neoplasm Staging
Phenotype
Prognosis
Receptor, Epidermal Growth Factor
Recurrence
Retrospective Studies
Receptor, Epidermal Growth Factor

Figure

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  Figure 1 Kaplan-Meier survival curve of study population (A) Disease-free survival (B) Overall survival.

• 

  Figure 2 Disease-free survival according to four groups of tumor biology. HR=hormone receptor; HER2=human epidermal growth factor receptor 2; TN=triple negative.

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  Figure 3 Subanalysis in HR+HER2– group according to Ki-67 level. HR=hormone receptor; HER2=human epidermal growth factor receptor 2.

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