腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响

目的探究腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响。方法选取2012年4月～2015年5月南京市妇幼保健院收治的476例行乳腺癌保乳手术后复发的乳腺癌病人作为研究对象。根据做乳腺癌保乳手术时腋窝淋巴结的状态分为腋窝淋巴结阳性组152例和腋窝淋巴结阴性组324例。观察并比较两组病人临床病理表现、生存情况,并分析复发后预后影响因素。结果两组病人的局部与区域复发情况差异无统计学意义(均P0.05)。两组病人的年龄、复发部位、雌激素受体(ER)及孕激素受体(PR)状态、人表皮生长因子受体2(HER-2)状态、无病间期、局部治疗和全身治疗差异均无统计学意义(均P0.05)。两组病人无远处转移生存率差异无统计学意义(P0.05),而阳性组患总生存率明显低于阴性组(P0.05)。Cox比例风险模型多因素分析显示,复发部位是乳腺癌保乳手术局部区域复发后无远处转移生存的独立影响因素(OR=2.052,P=0.003),腋窝淋巴结状态和复发部位是乳腺癌保乳手术局部区域复发后总生存的独立影响因素(OR=3.468,P=0.003;OR=677,P0.001)。结论腋窝淋巴结状态是乳腺癌保乳手术后复发病人总生存的独立影响因素,但对病人的无远处转移生存影响较小。     

乳腺癌激素受体状态与复发风险分布特征的相关研究

目的 研究不同激素受体(hormone receptor,HR)状态的乳腺癌患者术后复发风险时间分布特征.方法 回顾性研究北京肿瘤医院乳腺中心自1999年12月-2006年4月手术的1099例原发性乳腺癌患者激素受体状态的复发风险曲线模式.结果 所有患者均获得随访,中位随访时间60.6个月,1099例患者中171例复发.激素受体阴性(hormone receptor-negative,HR-)的乳腺癌患者,在术后第12个月出现第一个复发高峰,54个月左右出现第二个复发高峰.激素受体阳性(hormone receptor-positive,HR+)患者的第一峰在36个月出现,峰值较低且上升较缓和,约在54个月出现第二高峰,随后激素受体阳性肿瘤患者复发风险曲线高于激素受体阴性者.淋巴结阳性(lymphnode-positive,LN+)组与阴性(lymph node-negative,LN-)组在HR-组与HR+组有类似的复发风险曲线模式,淋巴结转移越多复发风险越高.HR+组中LN+亚组复发风险峰值高于LN-亚组2～3倍,HR-组中LN+亚组复发风险峰值高于LN-亚组3～4倍.HR(+)组无复发生存率高于HR(-)组(P＜0.01). 结论 HR+组乳腺癌术后54个月时复发风险高于HR-组,HR+组中LN+患者复发风险高于LN-者.     

胸段食管鳞癌根治术后淋巴结转移特点及对预后的影响

目的 研究胸段食管鳞癌根治术后淋巴结转移特点及对预后的影响,探讨合理的术后辅助治疗方案.方法 应用Spearman相关分析、Cox模型及Kaplan-Meier法等对204例患者的临床及随访资料进行多因素分析.结果 204例患者中淋巴结转移率为40.2%(82/204),转移度为7.57%(166/2193).相关因素分析显示:肿瘤浸润深度、肿瘤长度及细胞分化程度与淋巴结转移有关(χ2=17.466,11.494.6.767,P<0.05);患者年龄、肿瘤部位与淋巴结转移无关(χ2=1.086,3.897,P>0.05).生存分析显示:淋巴结转移个数<4枚组与≥4枚组1、3、5年生存率比较差异有统计学意义(χ2=4.493,4.494,4.450,P<0.05);有淋巴结转移较无淋巴结转移者易发生复发及转移(r=-2.060,-4.296,P<0.05).多因素分析显示:病理分期、分化程度、术后辅助治疗是独立的预后因素.结论 肿瘤长度、浸润深度及细胞分化程度与胸段食管鳞癌术后淋巴结转移有关,淋巴结转移状态及转移个数可影响预后.术后口服化疗药物对无淋巴结转移者生存有益.     

早期死亡风险评分对胰腺癌患者术后预后预测的价值

目的探讨早期死亡风险评分(early mortality risk score,EMRS)对胰腺癌患者术后预后的预测价值,寻找胰腺癌术后预后不良的早期预测方法。方法收集就诊并接受根治性手术治疗的370例胰腺癌患者的临床资料,记录患者的性别,年龄,体质指数(BMI),肿瘤部位、大小,合并基础疾病情况,术后生存时间,EMRS评分结果等信息。根据患者术后1年的临床结局(生存,死亡)将患者分为生存组和死亡组。单因素分析法比较组间上述指标的差异,选取单因素分析当中有差异的指标进一步进行Logistic多元回归分析,以确定胰腺癌患者术后预后不良的相关危险因素,并评价EMRS对胰腺癌患者术后预后的预测价值。结果本组370例患者,根据随访1年时的临床结局分为生存组(252例)和死亡组(118例),两组患者平均年龄、性别构成、合并基础疾病、既往吸烟史、近期体重变化、肿瘤分化程度、是否合并淋巴结转移、周围神经转移、血管转移、及术后并发症发生率比较,差异无统计学意义(P0.05);死亡组患者肿瘤相对较大,切缘阳性率、平均EMRS评分较高,组间比较差异有统计学意义(P0.05);且肿瘤大小,切缘阳性率、EMRS评分3项指标进行多元Logistic回归分析,结果显示,该3项指标均为胰腺癌患者术后早期预后不良的独立危险因子(OR均1.0,P均0.05);在EMRS=3.0时,其预测患者术后早期预后不良的敏感性和特异性分别为77.4%和82.3%。结论 EMRS与胰腺癌患者术后早期预后有关,高EMRS评分是胰腺癌患者术后早期预后不良的独立危险因子,EMRS评分3时,其预测胰腺癌患者术后早期预后不良的敏感性和特异性均较高。     

前哨淋巴结活检在乳腺癌治疗中的意义

自１８９４年Ｈａｌｓｔｅｄ报道Ｈａｌｓｔｅｄ乳腺癌根治术以来,腋淋巴结清扫一直是乳腺癌手术治疗中不可缺少的重要部分。腋淋巴结有无转移是影响乳腺癌病人预后最重要的因素,也是术后选择辅助治疗方案的重要依据。乳腺癌前哨淋巴结活检是乳腺外科领域在２０世纪９０年代中的一个里程碑式进展,其目的是藉此预测腋窝淋巴结有否肿瘤转移,使腋窝淋巴结阻性的乳腺癌病人免行腋淋巴结清扫。 前哨淋巴结的定义及其临床意义 前哨淋巴结是原发肿瘤引流区域淋巴结发生转移必经的第一个淋巴结,并以此进一步转移至远端淋巴结。前哨淋巴结作为有…     

乳腺癌分子分型与预后关系的研究

目的 探讨乳腺癌分子分型与预后之间的关系.方法 回顾性分析2002年1月至2003年12月接受手术治疗的708例原发性乳腺癌患者的临床资料.患者均为女性,平均年龄53岁.根据雌激素受体(ER)、孕激素受体(PR)及人类表皮生长因子受体2(HER2)状态的免疫组织化学结果,将全组乳腺癌分型为:内分泌高反应型、内分泌反应不完全型、三阴型及HER2阳性型,观察不同分子分型乳腺癌的预后,比较各型患者术后的累计生存率,多因素分析筛选预后相关因素.结果 本组内分泌高反应型、内分泌反应不完全型、HER2阳性型及三阴型乳腺癌所占的比例分别为33.2%(235/708)、23.6%(167/708)、21.3%(151/708)和21.9%(155/708).随访3～69个月,中位随访时间40.2个月,100例患者复发或死亡.单因素分析示乳腺癌预后与肿瘤大小、腋窝淋巴结状态、分子分型、术后辅助放疗及内分泌治疗有关;多因素分析示分子分型和淋巴结状态为乳腺癌的独立预后因素;生存分析示内分泌高反应型乳腺癌的预后好于其他三型.结论 乳腺癌分子分型是预后的独立预测因素,内分泌高反应型乳腺癌预后最好.     

甲状腺乳头状癌术后颈侧区复发影响因素分析

目的 分析甲状腺乳头状癌术后颈侧区复发的相关影响因素。方法 回顾性分析2018年1月～2022年12月我院经手术治疗的1 229例甲状腺乳头状癌病人的临床及病理资料。结果 1 229例病人中,术后复发70例,术后无复发1159例;经多因素Cox比例风险回归分析,肿瘤直径(HR:0.497,95%CI:0.287～0.858)、原发肿瘤个数(HR:2.037,95%CI:1.209～3.433)、侵犯包膜(HR:0.476,95%CI:0.251～0.903)、包膜外侵犯(HR:0.332,95%CI:0.169～0.657)可能是甲状腺乳头状癌病人术后颈侧区复发的影响因素。中央组淋巴结转移比例在多因素Cox风险比例回归分析中具有较好的预测价值(P<0.05),ROC曲线确定中央组淋巴结转移比例切点值为23.6%。结论 对于接受过手术治疗的甲状腺乳头状癌病人,多个原发灶、肿瘤直径>1 cm、有包膜或包膜外侵犯是甲状腺乳头状癌术后颈侧区复发的风险因素。中央组淋巴结转移比例≥23.6%,对术后颈侧区复发的风险有良好的预示作用。     

乳腺癌保乳治疗后局部复发的临床研究

目的 比较分析乳腺癌保乳治疗后局部复发病例与同期非复发病例资料,分析影响局部复发的风险因素.方法 密切随访2000年1月至2008年6月收治的1034例保乳治疗患者.患者年龄23～94岁,中位年龄48岁.分析年龄、雌激素受体(ER)/孕激素受体(PR)状态、人类表皮生长因子受体2(HER-2)状态、淋巴结转移状态、肿瘤大小、新辅助化疗、病理类型对局部复发的影响.结果 随访截至2010年6月,中位随访42个月(3～126个月),同侧乳房局部复发35例(3.3%),远位转移47例(4.5%),5年无病生存率87.7%,5年无远处转移生存率94.0%,5年总体生存率99.3%.单因素分析显示,淋巴结状态、年龄及HER-2表达状态是影响局部复发的风险因素;复发高峰时间为术后第2年至第3年,以及第5年至第6年;多因素分析显示HER-2状态是局部复发的独立影响因素.结论 保乳治疗后出现两个局部复发高峰时间段,HER-2表达状态是局部复发的独立影响因素,对于具有高危因素的患者需更积极治疗.     

乳腺癌行腋窝淋巴结清扫规范、争议与共识

乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移（cN0）的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。     

乳腺癌术后胸壁复发的临床分析：附113 例报告

目的：探讨乳腺癌术后胸壁复发的临床特征、治疗方法、预后情况。 方法：收集2004年1月—2014年6月新疆医科大学附属肿瘤医院收治的113例乳腺癌术后胸壁复发患者的临床资料,分析各项因素与患者生存期的关系。 结果：患者胸壁复发后生存期5~102个月,中位生存期41个月;1、2、5年生存率分别为100.0%、85.0%、38.0%。单因素分析显示,肿瘤大小、淋巴结转移状况、TNM分期、激素受体表达、HER-2受体表达、术后放疗、靶向治疗、内分泌治疗、胸壁复发前无病生存时间、复发灶的手术切除和放疗与乳腺癌胸壁单纯复发患者的生存期有关（P<0.05）;多因素分析显示,TNM分期、激素受体表达、HER-2受体表达、靶向治疗、胸壁复发前无病生存时间是胸壁复发后生存期的独立预后因素。 结论：乳腺癌术后胸壁复发的预后相对较好,综合治疗可能有助于提高治愈率。     

Axillary recurrence after modified radical mastectomy

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.     

Role of axillary node dissection in patients with T1a and T1b breast cancer: Mayo Clinic experience.

HYPOTHESIS: The incidence of nodal positivity in patients with early breast cancer is low, and axillary lymph node dissection may not be justified in all such patients. DESIGN: Retrospective case series. SETTING: Tertiary institution. PATIENTS: All patients with T1a and T1b breast cancer who had both primary breast surgery and axillary lymph node dissection at Mayo Clinic in Jacksonville, Fla, from January 1, 1992, through February 28, 1998. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Tumor size and biological grade, estrogen and progesterone receptor status, number of nodes harvested, and number of nodes positive for disease. RESULTS: Of 163 patients studied, 39 had T1a and 124 had T1b tumors. Node positivity was 0% for T1a and 11.3% for T1b tumors (P =.03). Lymph node involvement and estrogen receptor status were not related (P =.29). However, the risk of lymph node positivity for progesterone receptor-negative (P =.01) and estrogen receptor-negative/progesterone receptor-negative tumors was significantly higher than for progesterone and estrogen/progesterone receptor-positive tumors (P =.04). Furthermore, the risk of lymph node positivity was significantly higher as tumor size increased (P =.002). Finally, higher tumor grade conferred a higher risk of lymph node involvement (P =.02). CONCLUSIONS: T1a tumors have minimal risk of nodal positivity and may not require subsequent axillary lymph node dissection in the future. T1b tumors should be managed with routine analysis of axillary lymph node status. Whether sentinel node mapping can change this standard awaits further study.     

Clinical behavior of untreated axillary nodes after local treatment for primary breast cancer

Background: The purpose of this study was to examine the rate of axillary failure in patients with primary breast cancer treated without axillary dissection or radiation and to determine what factors may be associated with axillary failure. Methods: We studied 112 patients with invasive breast cancer treated for primary disease with breast-conserving surgery without axillary dissection or radiation to the breast or axilla, accrued between 1977 and 1986. Data for these patients were prospectively gathered for a research database and reviewed retrospectively to determine axillary failure. The effects of age, tumor size, estrogen receptor (ER) status, progesterone receptor (PgR) status, histologic grade, nuclear grade, and tumor emboli on time to axillary failure were examined. Results: The median follow-up was 9.6 years. There were 26 axillary recurrences, resulting in a 10-year actuarial nodal control rate of 72%. Patients with nodal failure proceeded to axillary dissection with minimal morbidity. In both univariate and multivariate analyses, only tumor size was significantly associated with axillary failure (p=0.04 andp=0.06, respectively). Conclusions: This study demonstrates a significant effect of tumor size on axillary failure and a reasonable rate of local control in small tumors. Further research should examine the utility of axillary dissection in women with small breast cancers.     

Sentinel Lymph Node Biopsy Alone Has No Adverse Impact on the Survival of Patients with Breast Cancer

Abstract:   We do not yet know the results from multicenter randomized trials comparing survival after sentinel lymph node biopsy (SLNB) alone and axillary lymph node dissection (ALND). Therefore, in this study, the prognostic significance of the type of axillary surgery is analyzed in combination with other known prognostic factors in patients with breast cancer. In a series of 1325 consecutive patients with unilateral breast cancer who underwent SLNB between January 1999 and June 2004 at a single institution, 884 underwent SLNB alone following an intraoperative negative histologic investigation and 441 underwent ALND. Disease-free survival (DFS) and overall survival (OS) were analyzed to correlate with clinicopathologic features and treatment methods using both univariate and multivariate analyses Cox proportional hazard regression models. With a median follow-up period of 31 months, 29 (3.3%) and 37 (8.4%) patients relapsed after SLNB alone and ALND, respectively. Tumor size (Tis, T1–2 versus T3–4), histologic nodal involvement (negative versus positive), nuclear grade (NG) (1, 2 versus 3), lymphatic vessel invasion (LVI) (absent, weak versus intense), estrogen receptor (ER) status (positive versus negative), type of axillary surgery (SLNB alone versus ALND), type of breast surgery (partial versus total mastectomy), and radiation therapy (yes versus no) significantly correlated with DFS by univariate analysis, demonstrating better DFS in the former category than the latter for each variable. The multivariate analysis revealed that NG, LVI, ER status, and radiation therapy significantly correlated with DFS, and ER and histologic nodal involvement correlated with OS. As the type of axillary surgery had no impact on the prognosis of patients with breast cancer, a SLNB alone is safe as determined by a negative histologic investigation.      

Breast cancer patients treated without axillary surgery: clinical implications and biologic analysis

OBJECTIVE: To evaluate the impact of breast carcinoma (T1-2N0) surgery without axillary dissection on axillary and distant relapses, and to evaluate the usefulness of a panel of pathobiologic parameters determined from the primary tumor, independent of axillary nodal status, in planning adjuvant treatment. METHODS: In a prospective nonrandomized pilot study, 401 breast cancer patients who underwent breast surgery without axillary dissection were accrued from January 1986 to June 1994. At surgery, all patients were clinically node-negative and lacked evidence of distant metastases after clinical or radiologic examination. A precise 4-month clinical and radiologic follow-up was performed to detect axillary or distant metastases. Patients with clinical evidence of axillary nodal relapse were considered for surgery as salvage treatment. Biologic characteristics of primary carcinomas were investigated by immunohistochemistry, and four pathologic and biologic parameters (size, grading, laminin receptor, and c-erbB-2 receptor) were analyzed to determine a prognostic score. RESULTS: The 5-year follow-up of these patients revealed a low rate of nodal relapses (6.7%), particularly for T1a and T1b patients (2% and 1.7%, respectively), whereas T1c and T2 patients showed a 10% and 18% relapse rate, respectively. Surgery was a safe and feasible salvage treatment without technical problems in all 19 cases of progressive disease at the axillary level. The low rate of distant metastases in T1a and T1b groups (<6%) increased to 15% in T1c and 34% in T2 patients. Analyzing the primary tumor with respect to the panel of pathologic and biologic parameters was predictive of metastatic spread and therefore can replace nodal status information for planning adjuvant treatment. CONCLUSIONS: Middle-term follow-up shows that the rate of axillary relapse in this patient population is lower than expected, suggesting that only a minimal number of microembolic nodal metastases become clinically evident. Avoidance of axillary dissection has a negligible effect on the outcome of T1 patients, particularly in T1a and T1b tumors with no palpable nodes, because the rate of axillary node relapse is very low for both. In T1 breast carcinoma, postsurgical therapy should be considered on the basis of biologic characteristics rather than nodal involvement. The authors' prognostic score based on the primary tumor identified patients who required postsurgical treatment, providing a practical alternative to axillary status for deciding on adjuvant treatment. Conversely, in the T2 group, the high rate of salvage surgery for axillary relapses, which is expected in tumors larger than 2.5 cm or 3.0 cm, represents a limit for avoiding axillary dissection. Preoperative evaluation of axillary nodes for modification of surgical dissection in this subgroup would be more useful more than in T1 breast cancer because of the high risk. Complete dissection is feasible without technical problems if precise follow-up detects progressive axillary disease.     

Breast-Conserving Surgery Versus Mastectomy for Survival from Breast Cancer: the Western Australian Experience

Background The focus of this study was the relative survival rates of breast cancer patients whose treatment was breast-conserving surgery compared with that of mastectomy, adjusting for tumor size and nodal status because these factors may be intrinsically associated with mastectomy being the treatment of choice. Patient age was also accounted for in the model. By adjusting for these factors, we mitigate them as confounders of treatment choice in assessing effects on survival rates. Methods Data were sourced from linked administrative data from the Western Australian Department of Health Record Linkage Unit. The data consisted of linked records containing the diagnosis, subsequent hospital admission, and death records of about 3000 women diagnosed with cancer in Western Australia between 1 January 1995 and 31 December 1999. Cox proportional hazards regression was used to investigate survival outcomes of breast-conserving surgery compared with that of mastectomy, adjusting for tumor size, nodal status, and subject age. Results The hazard of death is reduced by a factor of about one half for subjects whose treatment was breast-conserving surgery over treatment by mastectomy. Furthermore, the hazard of death increases substantially for subjects with nodal involvement over subjects for whom there has been no identified spread to regional lymph nodes. Hazard of death increases as both age and tumor size increase. Conclusions Western Australian breast cancer patients treated with breast-conserving surgery have improved survival outcomes over those treated with mastectomy, after allowing for tumor size, patient age, and lymph node involvement.     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

Axillary lymph node status,but not tumor size,predicts locoregional recurrence and overall survival after mastectomy for breast cancer

OBJECTIVE: To assess the significance of axillary lymph node status and tumor size for predicting locoregional recurrence (LRR) and overall survival after mastectomy for breast cancer and to discuss the utility of postmastectomy radiation therapy. SUMMARY BACKGROUND DATA: Patients with locally advanced breast cancer require multimodality treatment combining chemotherapy (and/or hormonal therapy), surgery, and radiation. Randomized trials have demonstrated that postmastectomy radiation reduces LRR, but no overall survival benefit has been established. METHODS: Criteria for accrual to the Alabama Breast Cancer Project (1975-1978) were female gender and T2-3 breast cancer with M0 status. Patients underwent a radical or a modified radical mastectomy. Node-positive patients received adjuvant cyclophosphamide, methotrexate, and fluorouracil chemotherapy or adjuvant melphalan. Patients were evaluated for LRR and overall survival based on the number of positive axillary lymph nodes and (in N0 patients) pathologic tumor size. Significance was determined using chi-square analysis. Survival curves were generated using the Kaplan-Meier method and were compared by log-rank analysis. RESULTS: After median follow-up of 15 years, neither type of surgery nor chemotherapy was shown to affect locoregional disease-free or overall survival. LRR rates were higher and overall survival rates were lower in patients with nodal involvement, while tumor size was not shown to significantly affect these rates. CONCLUSIONS: Patients with axillary lymph node metastases may benefit from postmastectomy radiation, but the use of postmastectomy radiation in N0 patients is not supported when it is based on tumor size alone.     

Prognostic Significance of Residual Breast Disease and Axillary Node Involvement for Patients Who Had Primary Induction Chemotherapy for Advanced Breast Cancer

Background We performed this study to determine the prognostic significance of clinical tumor size, pathologic measurement of residual tumor, and number of positive axillary nodes in the surgical specimen relative to overall survival for patients who underwent primary induction chemotherapy for advanced breast cancer. Methods Data, collected prospectively between 1997 and 2002, included clinical tumor-node-metastasis stage, age at diagnosis, hormone receptor status, type of preoperative chemotherapy, histological type, surgical procedure, pathologic measurement in centimeters of residual breast tumor, and the number of positive axillary nodes in the surgical specimen. Univariable correlates of residual breast disease were assessed by using the χ² test. Recursive partitioning analysis was used to determine the prognostic significance of clinical tumor size, residual tumor size, and pathologic node involvement relative to overall survival. Survival was estimated by using the method of Kaplan and Meier and compared by using the log-rank test. A P value of < .05 was considered significant. Results Data were available for 85 patients with advanced breast cancer. Although univariable analysis identified increasing age, clinically involved axillary nodes, and a higher clinical tumor-node-metastasis stage as predictors of an increased risk of residual disease, recursive partitioning analysis identified more than three involved axillary nodes in the surgical specimen, with or without any measurable residual breast disease, as the most significant predictor of decreased survival (P < .001). Conclusions Pathologic axillary node involvement was the most significant predictor of decreased survival for patients who had undergone primary induction chemotherapy for advanced breast cancer.     

Prognostic Factors for Metachronous Contralateral Breast Cancer: Implications for Management of the Contralateral Breast

The absolute number of breast cancer survivors who are at risk for metachronous contralateral breast cancer (mCBC) has dramatically increased. The objectives of this study were to identify factors predictive of survival for patients with mCBC and to determine clinicopathological factors predictive of advanced mCBC. Using the Surveillance, Epidemiology, and End Results data base, we identified women, ages 18–80, diagnosed with invasive breast cancer from 1992 to 2010. We excluded patients with bilateral and stage IV primary breast cancer. Patients who developed mCBC ≥12 months from initial diagnosis were identified. Kaplan–Meier methods and Cox proportional hazards modeling were used to determine survival of patients with mCBC. Multivariate logistic regression was utilized to determine factors associated with advanced mCBC. We identified 6,673 patients who developed mCBC during our study period. The median interval between initial breast cancer and mCBC was 5 years. The strongest predictor of overall survival was the nodal status of the mCBC. Other significant prognostic factors included patient age; race; size, nodal status, estrogen receptor status, grade, and type of surgery of the initial breast cancer; grade of the mCBC; and use of radiation therapy for the mCBC. Overall, 25% of mCBCs were node positive. Younger age, black race, and characteristics of the initial breast cancer (increased size, invasive lobular histology, mastectomy treatment, and node‐positivity) were significantly associated with node‐positive mCBC (all p < 0.0.05). The most powerful predictor of survival for patients with mCBC is the nodal status of mCBC. Patients with advanced initial breast cancers are more likely to develop node‐positive mCBC. Adherence to current surveillance and adjuvant therapy guidelines may minimize the risk and mortality of mCBCs.