title: Percent positive axillary lymph node metastasis predicts survival in patients with non-metastatic breast cancer.
abstract: OBJECTIVE
  We retrospectively evaluated the impact of percent positive axillary nodal involvement on the therapeutic outcomes in patients with non-metastatic breast cancer receiving postmastectomy radiotherapy and chemotherapy.
  
  
  METHODS
  Between January 1994 and December 2002, the medical records of 939 eligible non metastatic breast carcinoma patients were analyzed. Chest wall radiotherapy was indicated in case of positive surgical margin, tumor size equal or more than 4 cm, skin-fascia invasion. Lymphatic irradiation was applied for more than three metastatic axillary lymph nodes, incomplete axillary dissection (<10 lymph nodes), extracapsular extension or perinodal fat tissue invasion. A total dose of 50 Gy was given to chest wall and lymph node regions with 2 Gy daily fractions. Statistical analyses were performed by Kaplan-Meier method, Log-rank test and Cox's regression analysis.
  
  
  RESULTS
  The median follow-up for all patients alive was 62 months. The 5-year overall survival (OS) and disease-free survival (DFS) for entire cohort were 81%, and 65%, respectively. Univariate analysis for OS revealed significance for tumour size (< or =5 cm vs. >5 cm, p<0.001), metastatic nodal involvement (0 vs. 1-3 vs. >4 LN, p<0.001), percent positive nodal involvement ([metastatic nodes/total nodes removed] x 100; 0 vs. < or =25% vs. 26-50% vs. >50%, p<0.001), surgical margin status (negative vs. positive, p=0.05), and hormonal treatment (present vs. absent, p=0.03). DFS had similarly significance for age (< or =40 years vs. >40 years, p=0.006), tumour size (0.02), metastatic nodal involvement (p<0.001), percent positive nodal involvement (p<0.001), and perinodal invasion (present vs. absent, p=0.01). Multivariate analysis revealed significance for tumour size, percent positive nodal involvement, hormonal treatment, and surgical margin status for OS. Age and percent positive nodal involvement were found to be significant for DFS.
  
  
  CONCLUSIONS
  Percent positive nodal involvement was found to be a significant prognostic factor for survival in all end-points.
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sohhiye, Ankara, Turkey.
authors.forename: Ibtisam
authors.initials: I
authors.lastname: Lale Atahan
authors.forename: Ferah
authors.initials: F
authors.lastname: Yildiz
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozyigit
authors.forename: Sait
authors.initials: S
authors.lastname: Sari
authors.forename: Murat
authors.initials: M
authors.lastname: Gurkaynak
authors.forename: Ugur
authors.initials: U
authors.lastname: Selek
authors.forename: Mutlu
authors.initials: M
authors.lastname: Hayran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors