title: Long-term survival of women with locally advanced breast cancer with ≥ 10 involved lymph nodes at diagnosis.
abstract: BACKGROUND
  Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival. In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy.
  
  
  METHODS
  In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and 5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysis for time-to-event data, using the extended Cox regression model was carried out.
  
  
  RESULTS
  With a median and mean follow-up of 70 and 89.9 months, respectively, the overall median survival was estimated to be 99 months. The five-year disease-free survival (DFS) was 59.3% and the ten-year DFS was 37.9%, whereas the five- and ten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significant improvement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among young patients (ages 21-45) compared to elderly patients (age greater than 70) (p=0.00176, p=0.0034, respectively), and improved DFS and OS among patients whose tumors were ER positive (p=0.049, p=0.0034).
  
  
  CONCLUSIONS
  In this single institution study of patients with greater than 10 positive axillary nodes, black patients had a significantly improved DFS compared with white patients. Young age and ER tumor positivity was associated with improved outcomes. Using multivariate analysis, there were no other variables associated with statistically significant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breast cancer survival in this subgroup of patients.
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA E-mail : simonzeichner@gmail.com.
authors.forename: Simon Blechman
authors.initials: SB
authors.lastname: Zeichner
authors.forename: Ludimila
authors.initials: L
authors.lastname: Cavalcante
authors.forename: Gabriel Pius
authors.initials: GP
authors.lastname: Suciu
authors.forename: Ana Lourdes
authors.initials: AL
authors.lastname: Ruiz
authors.forename: Alicia
authors.initials: A
authors.lastname: Hirzel
authors.forename: Elisa
authors.initials: E
authors.lastname: Krill-Jackson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen