Early stage extremely high risk breast cancer patients with involvement of five and over axillary lymph nodes: retrospective comparative analyzes of predictive and prognostic factors in-between the survivors of five years and over and the patients with recurrence and metastasis

Predictive and prognostic factors are extremely important for the adjuvant treatment decisions in early stage breast cancer with metastatic axillary nodes. The aim of this study was to analyze high risk breast cancer patients with involvement of five and over axillary lymph nodes retrospectively, and to determine the predictive and prognostic factors by comparing patients with an overall survival of at least five years (study group) with patients those have tumor recurrence and/or metastasis (control group). From a total of 500 patients those were followed-up in-between January 2000 and May 2013, in Adnan Menderes University, Medical Oncology Department, 37 were meeting the study criteria, of them; 23 were disease free for at least five years (study group) and 14 had recurrences/metastases in the follow-up (control group). The patients were analyzed generally and comperatively, for demographical (such as age, menapousal status, and obesity), anatomical and histological characteristics (such as primary tumor?s diameter, stage, grade, Ki67, hormon receptors, and Her2/neu status), treatment modalities (surgical treatments, chemotherapy, radiotherapy, hormonal and biological therapies) and prognosis (disease free and overall survival). Both number of metastatic lymph nodes and (metastatic/sampled) lymph node ratio oranı was not significantly different in-between the study and the control groups. In the study group both ?grade 3? (48% vs. none, respectively; p=0,03) and ?p53(-)? (64% vs. 36%, respectively; p=0.036) tumors were significantly more than the controls. Also in the study group as compared to controls; adjuvant chemotherapy was applied more than 6 cycles (87% vs. 43%, respectively; p=0.004), the regimens included more taxane group agents (91% vs. 64%, respectively; p=0.042), aromatase inhibitors were used in more patients (100% vs. 75%, respectively; p=0.019) and the period of tamoxifen treatment in switch regimens were shorter (22.2±4 and 39.7±14.7 months, respectively; p=0.004). In conclusion, the results of this study suggested that, high risk breast cancer patients with involvement of five and more nodes that have the predictive factors as ?grade 3? and/or ?p53 (-)? tumors are probably more responsive to adjuvant treatments. Chemotherapy of more than 6 cycles, administering taxane-based rejimens and aromatase inhibitors in the adjuvant regimens may favourably affect the prognosis. Key Words: Early stage breast cancer, lymph node metastasis, predictive and prognostic factors