Skip to main content

Advertisement

Log in

Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management

  • Brief Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Extensive lymph node (LN) involvement portends significant risk for distant metastasis (DM) among breast cancer patients. As a result, local management may be of secondary import to systemic control in this population. We analyzed patients with ≥10 involved LNs (N3) to evaluate the feasibility of breast conserving therapy (BCT) vs modified radical mastectomy (MRM) in this high-risk cohort. Among 98 women with N3 disease 46 (46.9 %) underwent BCT and 52 (53.1 %) received MRM. Nearly all patients (92 %) received comprehensive radiotherapy (RT) including axillary and supraclavicular fields. The Kaplan–Meier method and Cox regression analyses were used to analyze time-to-event outcomes. Median follow-up was 76 months, with a 5-year DFS of 64.9 % and OS of 71.9 % among the cohort. Poorly differentiated (p = 0.007), ER-negative tumors (p = 0.015) had adverse DFS outcomes. Treatment groups did not differ with regard to 10-year DFS (45.4 % for MRM vs. 57.6 % for BCT; p = 0.31), or OS (61.4 vs. 63.7 %; p = 0.79). DM-free survival was 48.9 % following MRM and 60.6 % following BCT (p = 0.19). Patients with ≥10 involved LNs have similar outcomes following BCT or MRM, suggesting that RT may obviate the need for more-extensive surgery. While local control is comparably favorable regardless of surgical approach, systemic control remains a challenge in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Early Breast Cancer Trialists’ Collaborative Group (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716

    Article  Google Scholar 

  2. Kwong D et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383(9935):2127–2135

    Article  Google Scholar 

  3. EBCTCG (2006) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

    Google Scholar 

  4. Mahmood U et al (2012) Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer. Int J Radiat Oncol Biol Phys 83(5):1387–1393

    Article  PubMed  Google Scholar 

  5. Martinez-Ramos D et al (2012) Risk of recurrence of non-metastatic breast cancer in women under 40 years: a population-registry cancer study in a European country. Breast J 18(2):118–123

    Article  PubMed  Google Scholar 

  6. Hwang ES et al (2013) Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer 119(7):1402–1411

    Article  PubMed Central  PubMed  Google Scholar 

  7. Walker MJ et al (1995) The natural history of breast cancer with more than 10 positive nodes. Am J Surg 169(6):575–579

    Article  CAS  PubMed  Google Scholar 

  8. Geara FB et al (2007) Breast cancer patients with 10 or more involved axillary lymph nodes treated by multimodality therapy: influence of clinical presentation on outcome. Int J Radiat Oncol Biol Phys 68(2):364–369

    Article  PubMed  Google Scholar 

  9. Clarke M, Early Breast Cancer Trialists Collaborative Group (EBCTCG) et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

    Article  CAS  PubMed  Google Scholar 

  10. Zander A et al (2004) High-dose chemotherapy with autologous hematopoietic stem-cell support compared with standard-dose chemotherapy in breast cancer patients with 10 or more positive lymph nodes: first results of a randomized trial. J Clin Oncol 22(12):2273–2283

    Article  CAS  PubMed  Google Scholar 

  11. Rodenhuis S et al (1998) Randomised trial of high-dose chemotherapy and haemopoietic progenitor-cell support in operable breast cancer with extensive axillary lymph-node involvement. Lancet 352(9127):515–521

    Article  CAS  PubMed  Google Scholar 

  12. Gianni A et al (1997) Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results. J Clin Oncol 15(6):2312–2321

    CAS  PubMed  Google Scholar 

  13. Crump M et al (1996) Outcome of extensive evaluation before adjuvant therapy in women with breast cancer and 10 or more positive axillary lymph nodes. J Clin Oncol 14(1):66–69

    CAS  PubMed  Google Scholar 

  14. Singletary SE et al (2003) Staging system for breast cancer: revisions for the 6th edition of the AJCC cancer staging manual. Surg Clin N Am 83(4):803–819

    Article  PubMed  Google Scholar 

  15. Taghian A et al (2004) Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 22(21):4247–4254

    Article  PubMed  Google Scholar 

  16. Recht A et al (1999) Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 17(6):1689

    CAS  PubMed  Google Scholar 

  17. Van Belle V et al (2009) Lymph node ratio better predicts disease-free survival in node-positive breast cancer than the number of positive lymph nodes. J Clin Oncol 27(30):e150–e151

    Article  PubMed  Google Scholar 

  18. Arvold ND et al (2011) Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol 29(29):3885–3891

    Article  PubMed Central  PubMed  Google Scholar 

  19. Sotiriou C et al (2006) Gene expression profiling in breast cancer: understanding the molecular basis of histologic grade to improve prognosis. J Natl Cancer Inst 98(4):262–272

    Article  CAS  PubMed  Google Scholar 

  20. Fisher B et al (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333(22):1456–1461

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alphonse G. Taghian.

Ethics declarations

Conflicts of interest

None.

Additional information

Lior Z. Braunstein and Sigolene Galland-Girodet have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Braunstein, L.Z., Galland-Girodet, S., Goldberg, S. et al. Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management. Breast Cancer Res Treat 154, 633–639 (2015). https://doi.org/10.1007/s10549-015-3642-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3642-6

Keywords

Navigation