Skip to main content

Advertisement

SpringerLink
Log in

Is there any Prognostically Different Subgroup among Patients with Stage IIIC (Any TN3M0) Breast Carcinoma?

  • Breast Oncology
  • Original Papers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 26 February 2008

Abstract

Background

We investigated whether there are prognostically different subgroups among patients with stage IIIC (anyTN3M0) breast carcinoma.

Methods

The file records of 348 female patients operated for stage IIIC breast carcinoma were reviewed. The endpoint was disease recurrence.

Results

Patients with a T1, T2 or T3 tumor had significantly better disease-free survival (DFS) compared to those with a T4 tumor. In the patient group with T1,2,3N3M0 disease, the DFS was significantly better in patients with between 10 and 15 metastatic axillary lymph nodes, compared to patients with 16 or more metastatic lymph nodes (p = 0.0360) and in patients with a nodal ratio ( number of metastatic lymph nodes divided by number of removed nodes) less than or equal to 0.80, compared to patients with a nodal ratio greater than 0.80 (p = 0.0003). In the patient subgroup with between 10 and 15 metastatic lymph nodes, those with a nodal ratio greater than 0.80 had significantly worse DFS, whereas in the patient subgroup with 16 or more metastatic lymph nodes the nodal ratio had no prognostic significance. The DFS of patients with 10 to 15 positive lymph nodes and a nodal ratio of up to 0.80 was significantly better than that of both the patients with 10 to 15 positive lymph nodes and a nodal ratio greater than 0.80 (p = 0.0002), and the patients with 16 or more positive lymph nodes (p = 0.0002); survival of the latter two patient groups was similar.

Conclusions

Patients with T1,2,3N3M0 disease can be divided into prognostically different subgroups according to the number of metastatic lymph nodes in the axilla and the nodal ratio; in this way, different patient subgroups may be offered different treatment strategies.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.
FIG. 3.
FIG. 4.
FIG. 5.

Similar content being viewed by others

References

  1. Greene FL, Page DL, Fleming ID, et al. (eds). AJCC Cancer Staging Manual. 6th ed. New York: Springer; 2002

    Google Scholar 

  2. Fleming ID, Cooper JS, Henson DE, et al. (eds). AJCC Cancer Staging Manual. 5th ed. Philadelphia: Lippincott-Raven; 1997

    Google Scholar 

  3. Duraker N, Çaynak ZC. Prognostic value of the 2002 TNM classification for breast carcinoma with regard to the number of metastatic axillary lymph nodes. Cancer 2005;104:700–7.

    Article  PubMed  Google Scholar 

  4. Tallman MS, Gray R, Robert NJ, et al. Conventional adjuvant chemotherapy with or without high-dose chemotherapy and autologous stem-cell transplantation in high-risk breast cancer. N Engl J Med 2003;349:17–26

    Article  PubMed  CAS  Google Scholar 

  5. Zander AR, Kröger N, Schmoor C, et al. 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 2004;22:2273–83

    Article  PubMed  CAS  Google Scholar 

  6. Peters WP, Rosner GL, Vredenburgh JJ, et al. Prospective, randomized comparison of high-dose chemotherapy with stem-cell support versus intermediate-dose chemotherapy after surgery and adjuvant chemotherapy in women with high-risk primary breast cancer: a report of CALGB 9082, SWOG 9114, and NCIC MA-13. J Clin Oncol 2005;23:2191–200

    Article  PubMed  Google Scholar 

  7. Coombes RC, Howell A, Emson M, et al. High dose chemotherapy and autologous stem cell transplantation as adjuvant therapy for primary breast cancer patients with four or more lymph nodes involved: long-term results of an international randomized trial. Ann Oncol 2005;16:726–34

    Article  PubMed  CAS  Google Scholar 

  8. Hanrahan EO, Broglio K, Frye D, et al. Randomized trial of high-dose chemotherapy and autologous hematopoietic stem cell support for high-risk primary breast carcinoma: follow-up at 12 years. Cancer 2006;106:2327–36.

    Article  PubMed  CAS  Google Scholar 

  9. Rodenhuis S, Bontenbal M, Beex LVAM, et al. High-dose chemotherapy with hematopoietic stem-cell rescue for high-risk breast cancer. N Engl J Med 2003;349:7–16

    Article  PubMed  CAS  Google Scholar 

  10. Nitz UA, Mohrmann S, Fischer J, et al. Comparison of rapidly cycled tandem high-dose chemotherapy plus peripheral-blood stem-cell support versus dose-dense conventional chemotherapy for adjuvant treatment of high-risk breast cancer: results of a multicentre phase III trial. Lancet 2005;366:1935–44

    Article  PubMed  CAS  Google Scholar 

  11. Nieto Y, Cagnoni PJ, Shpall EJ, et al. A predictive model for relapse in high-risk primary breast cancer patients treated with high-dose chemotherapy and autologous stem-cell transplant. Clin Cancer Res 1999;5:3425–31

    PubMed  CAS  Google Scholar 

  12. Bolwell B, Andresen S, Pohlman B, et al. Prognostic importance of the axillary lymph node ratio in autologous transplantation for high-risk stage II/III breast cancer. Bone Marrow Transplant 2001;27:843–6

    Article  PubMed  CAS  Google Scholar 

  13. Schneeweiss A, Goerner R, Hensel M, et al. Tandem high-dose chemotherapy in high-risk primary breast cancer: a multivariate analysis and a matched-pair comparison with standard-dose chemotherapy. Biol Blood Marrow Transplant 2001;7:332–42

    Article  PubMed  CAS  Google Scholar 

  14. Nieto Y, Nawaz S, Shpall EJ, Bearman SI, Murphy J, Jones RB. Long-term analysis and prospective validation of a prognostic model for patients with high-risk primary breast cancer receiving high-dose chemotherapy. Clin Cancer Res 2004;10:2609–17

    Article  PubMed  CAS  Google Scholar 

  15. Nemoto T, Vana J, Bedwani RN, Baker HW, McGregor FH, Murphy GP. Management and survival of female breast cancer: results of a national survey by the American College of Surgeons. Cancer 1980;45:2917–24

    Article  PubMed  CAS  Google Scholar 

  16. Fisher B, Bauer M, Wickerham L, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: an NSABP update. Cancer 1983;52:1551–7

    Article  PubMed  CAS  Google Scholar 

  17. Kuru B. Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma. Eur J Surg Oncol 2006;32:1082–8

    Article  PubMed  CAS  Google Scholar 

  18. Van der Wal BCH, Butzelaar RMJM, van der Meij S, Boermeester MA. Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage I and II breast cancer. Eur J Surg Oncol 2002;28:481–9

    Article  PubMed  Google Scholar 

  19. Woordeckers M, Vinh-Hung V, Van de Steene J, Lamote J, Storme G. The lymph node ratio as prognostic factor in node-positive breast cancer. Radiother Oncol 2004;70:225–30

    Article  Google Scholar 

  20. Joslyn SA, Konety BR. Effect of axillary lymphadenectomy on breast carcinoma survival. Breast Cancer Res Treat 2005;91:11–8.

    Article  PubMed  Google Scholar 

  21. Truong PT, Berthelet E, Lee J, Kader HA, Olivotto IA. The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes. Cancer 2005;103:2006–14.

    Article  PubMed  Google Scholar 

  22. Fortin A, Dagnault A, Blondeau L, Vu TTT, Larochelle M. The impact of the number of excised axillary nodes and of the percentage of involved nodes on regional nodal failure in patients treated by breast-conserving surgery with or without regional irradiation. Int J Radiat Oncol Biol Phys 2006;65:33–9.

    PubMed  Google Scholar 

  23. Jatoi I. Management of the axilla in primary breast cancer. Surg Clin North Am 1999;79:1061–73.

    Article  PubMed  CAS  Google Scholar 

  24. Ruffin WK, Stacey-Clear A, Younger J, Hoover HC. Rationale for routine axillary dissection in carcinoma of the breast. J Am Coll Surg 1995;180:245–51.

    PubMed  CAS  Google Scholar 

  25. Moore MP, Kinne DW. Axillary lymphadenectomy: a diagnostic and therapeutic procedure. J Surg Oncol 1997;66:2–6.

    Article  PubMed  CAS  Google Scholar 

  26. Morrow M. A survival benefit from axillary dissection: was Halsted correct? Ann Surg Oncol 1999;6:17–8

    Article  PubMed  CAS  Google Scholar 

  27. McMasters KM. The eternally enigmatic axilla: further controversy about axillary lymph nodes in breast cancer. Ann Surg Oncol 2003;10:1128–30.

    Article  PubMed  Google Scholar 

  28. Luini A, Gatti G, Ballardini B, et al. Development of axillary surgery in breast cancer. Ann Oncol 2005;16:259–62.

    Article  PubMed  CAS  Google Scholar 

  29. Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomized controlled study. Lancet Oncol 2006;7:983–90.

    Article  PubMed  Google Scholar 

  30. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:7703–20.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Fifth Department of Surgery, SSK Okmeydanı Training Hospital, Istanbul, Turkey

    Nüvit Duraker MD, Zeynep C. Çaynak MD & Bakır Batı MD

Authors
  1. Nüvit Duraker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zeynep C. Çaynak MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bakır Batı MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nüvit Duraker MD.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1245/s10434-008-9826-0

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duraker, N., Çaynak, Z.C. & Batı, B. Is there any Prognostically Different Subgroup among Patients with Stage IIIC (Any TN3M0) Breast Carcinoma?. Ann Surg Oncol 15, 430–437 (2008). https://doi.org/10.1245/s10434-007-9558-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9558-6

Keywords

Search

Navigation