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Published on: May 17, 2024
Long-term outcome of breast cancer patients with pathologic N3a lymph node stage
Antonino Grassadonia1, Patrizia Vici2, Teresa Gamucci3
1Department of Medical, Oral and Biotechnological Sciences, Center of Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti, Italy.
Purpose:
To evaluate factors influencing the long-term outcome of patients presenting with 10 or more metastatic axillary lymph nodes (pN3a) after surgery for primary breast cancer.
Method:
Between January 1990 and December 2015, a total of 130 patients with pN3a breast cancer at surgery were identified in our Institutions and included in the study. Twenty-nine of them (22.3%) received neoadjuvant chemotherapy. The Multivariate Cox proportional hazards model was used to determine independent prognostic factors associated with DFS and OS.
Results:
After a median follow-up of 6.4 years (range 0.87-25 years), 2 patients had a local relapse, 59 distant metastases (1 with local relapse) and 52 patients died. The 5-year DFS and OS rates were 61.8% and 71.5%, respectively. At multivariate analysis, pN3a stage after neoadjuvant chemotherapy (ypN3a) was significantly associated with increased risk of recurrence (HR 1.92, p = 0.02) and death (HR 2.05, p = 0.029). Absence of progesterone receptor (PR) expression was the most important tumor characteristic associated with poor prognosis, both in terms of recurrence (HR 2.55, p < 0.001) and death (HR 2.23, p = 0.019). High levels of Ki-67 index (≥20%) were significantly associated with a shorter OS (HR 2.03, p = 0.027), but not with DFS.
Conclusions:
The results of this study indicate that ypN3a stage, lack of expression of PR, and Ki-67 ≥ 20% negatively affect long-term outcome of patients with pN3a breast cancer.