title: Clinical Outcomes and Prognostic Factors of Pathologic N3 Breast Cancer Treated With Modern Standard Treatments.
abstract: BACKGROUND
  The aim of the present study was to investigate clinical outcomes and identify prognostic factors in pathologic N3 (pN3) breast cancer patients who received the current standard management.
  
  
  METHODS
  We performed a retrospective study with 333 pN3 breast cancer patients who received curative surgery with postoperative radiation therapy and taxane-based adjuvant chemotherapy from January 2000 to June 2012. The median follow-up period was 58.3 months (range, 7.4-167.9 months). All of the 243 patients who were hormone receptor-positive received endocrine therapy, and trastuzumab therapy was used in 63 of 88 (71.6%) HER2-positive patients.
  
  
  RESULTS
  Overall, 112 disease recurrences (33.6%) were documented during the follow-up. The first site of recurrence was locoregional in 21 patients (6.3%), distant metastases in 72 patients (21.6%), and both in 19 patients (5.7%). The disease-free survival (DFS) and overall survival were 63.3% and 86.9% at 5 years, respectively. DFS was significantly related to age (> 40 years; P = .008; hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.40-0.87), nuclear grade (I or II; P = .02; HR, 0.64; 95% CI, 0.44-0.93), and positive lymph node ratio (≤ 60%; P = .004; HR, 0.56; 95% CI, 0.38-0.83) in multivariate analysis. HER2-positive patients who were treated with trastuzumab showed more favorable DFS than HER2-negative patients.
  
  
  CONCLUSIONS
  More than 60% of the pN3 breast cancer patients treated with the current standard management lived without disease longer than 5 years. Age, nuclear grade, and lymph node ratio were significant prognostic factors in pN3 breast cancer patients.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Il
authors.initials: JI
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: wonro.park@samsung.com.
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Eon
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kil
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young-Hyuck
authors.initials: YH
authors.lastname: Im
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yeon Hee
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Eun Yun
authors.initials: EY
authors.lastname: Cho
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; N3; Prognosis; Prognostic factor; Recurrence