Estrogen receptor status is the most important prognostic factor in breast cancer with ten or more positive lymph nodes

Background. In breast cancer, the prognosis worsens with increasing lymph node involvement, and aggressive therapies may prolong survival in patients with advanced breast cancer. However, there are sub-populations of patients with advanced breast cancer with ten or more diseased nodes who have long survival. Implementing appropriate treatment depends on having a realistic and well-founded view of the prognosis. Methods. Sixty-nine patients (mean follow-up, 46 months) were enrolled. All patients underwent adjuvant therapy following radical mastectomy. Thirty-seven patients relapsed after curative surgery and 40 died of their cancer. Clinicopathologic factors, tumor estrogen receptor (ER) status, progesterone receptor status, and p53 protein expression were analyzed for prognostic significance. Results. Lower lymph node stage and positive ER status reflected longer relapse-free survival (P = 0.001 and P = 0.0001, respectively). Lower tumor stage (P = 0.039), lower lymph node stage (P = 0.006), absence of distant metastasis (P = 0.006), positive ER status (P = 0.0002), and negative p53 status (P = 0.02) reflected longer overall survival. ER status was the only independent significant prognostic factor for both relapse-free and overall survival. Conclusion. ER status, an indicator of response to endocrine therapy, was the most significant factor predicting prognosis in patients with breast cancer with ten or more positive lymph nodes. Received: February 25, 1998 / Accepted: December 24, 1998