title: Long-term outcome of breast cancer patients with pathologic N3a lymph node stage.
abstract: OBJECTIVE
  To evaluate factors influencing the long-term outcome of patients presenting with 10 or more metastatic axillary lymph nodes (pN3a) after surgery for primary breast cancer.
  
  
  METHODS
  Between January 1990 and December 2015, a total of 130 patients with pN3a breast cancer at surgery were identified in our Institutions and included in the study. Twenty-nine of them (22.3%) received neoadjuvant chemotherapy. The Multivariate Cox proportional hazards model was used to determine independent prognostic factors associated with DFS and OS.
  
  
  RESULTS
  After a median follow-up of 6.4 years (range 0.87-25 years), 2 patients had a local relapse, 59 distant metastases (1 with local relapse) and 52 patients died. The 5-year DFS and OS rates were 61.8% and 71.5%, respectively. At multivariate analysis, pN3a stage after neoadjuvant chemotherapy (ypN3a) was significantly associated with increased risk of recurrence (HR 1.92, p = 0.02) and death (HR 2.05, p = 0.029). Absence of progesterone receptor (PR) expression was the most important tumor characteristic associated with poor prognosis, both in terms of recurrence (HR 2.55, p < 0.001) and death (HR 2.23, p = 0.019). High levels of Ki-67 index (≥20%) were significantly associated with a shorter OS (HR 2.03, p = 0.027), but not with DFS.
  
  
  CONCLUSIONS
  The results of this study indicate that ypN3a stage, lack of expression of PR, and Ki-67 ≥ 20% negatively affect long-term outcome of patients with pN3a breast cancer.
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, Center of Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti, Italy. Electronic address: grassadonia@unich.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Grassadonia
authors.affiliation: Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
authors.affiliation: Department of Oncology, Division of Medical Oncology, Belcolle Hospital, ASL Viterbo, Viterbo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Moscetti
authors.affiliation: Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pizzuti
authors.affiliation: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mentuccia
authors.affiliation: Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy; Breast Medical Oncology Unit, G. Bernabeo Hospital, Ortona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Iezzi
authors.affiliation: Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy; Breast Medical Oncology Unit, G. Bernabeo Hospital, Ortona, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Scognamiglio
authors.affiliation: Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy; Breast Medical Oncology Unit, G. Bernabeo Hospital, Ortona, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Zilli
authors.affiliation: Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy; Breast Medical Oncology Unit, G. Bernabeo Hospital, Ortona, Italy.
authors.forename: Jamara
authors.initials: J
authors.lastname: Giampietro
authors.affiliation: Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy; Breast Medical Oncology Unit, G. Bernabeo Hospital, Ortona, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Graziano
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, Center of Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Natoli
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, Center of Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tinari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000737:chemistry / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D019394:Ki-67 Antigen / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D019394:Ki-67 Antigen; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Breast cancer; Ki-67; Progesterone Receptor; Prognosis; Stage pN3a