title: Favorable outcome of secondary axillary dissection in breast cancer patients with axillary nodal relapse.
abstract: OBJECTIVE
  Little evidence can be found about the long-term outcome of breast cancer patients after axillary lymph node recurrence (ALNR) and its survival benefit after different kinds of management. The present study intends to evaluate the risk factors associated with axillary recurrence after definite surgery for primary breast cancer. The prognosis after ALNR and particularly outcome of different management methods also were studied.
  
  
  METHODS
  We retrospectively reviewed data from 4,473 patients who were diagnosed with primary breast cancer and received surgical intervention in a single institute from January 1990 to December 2002. Medical files were reviewed and data on survival were updated annually. Risk factors and prognosis of patients with axillary recurrence were analyzed. Breast-cancer-specific survival of patients with ALNR and outcomes after different management methods also were studied.
  
  
  RESULTS
  After a median follow-up of 70.2 months, axillary recurrence developed in 0.8% of patients. Factors associated with ALNR included: age younger than 40 years, medial tumor location, no initial standard level I & II axillary dissection, and not receiving hormonal therapy. The 5-year breast-cancer-specific survival after ALNR was 57.9%. For patients who received further axillary dissection, the 5-year survival rate was 82.5% compared with 44.9% for patients who did not receive further dissection.
  
  
  CONCLUSIONS
  ALNR is a rare event in treating breast cancer. Young age at diagnosis and medially located tumor are associated with higher risk, but standardized initial axillary dissection to level II and adjuvant hormonal therapy is protective against ALNR. In patients with ALNR, the outcome is not dismal and survival may be improved if further axillary dissection is given.
authors.affiliation: Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.
authors.forename: Shih-Che
authors.initials: SC
authors.lastname: Shen
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.forename: Yung-Feng
authors.initials: YF
authors.lastname: Lo
authors.forename: Hsiu-Pei
authors.initials: HP
authors.lastname: Tsai
authors.forename: Wen-Lin
authors.initials: WL
authors.lastname: Kuo
authors.forename: Chi-Chang
authors.initials: CC
authors.lastname: Yu
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.forename: Hsien-Kun
authors.initials: HK
authors.lastname: Chang
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Shen
authors.forename: Shir-Hwa
authors.initials: SH
authors.lastname: Ueng
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Huang
authors.forename: Shin-Cheh
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate