Evaluation of LYMPH node metastasis and the effect of predictive factors in breast cancer according to age

Introduction: In lymph node metastasis, which is one of the most important factors in determining the treatment and prognosis of breast cancer, the effects of predictive factors such as tumor size, histological grade, hormone receptor status and her 2/neu expression, ki-67 proliferation index, lymphovascular invasion have been evaluated in many previous studies. Although it is widely accepted that breast cancer behaves less aggressively as age increases, it is stated in some publications that tumors may show an aggressive course in breast cancers that occur at a later age, as in early ages. In addition, some studies have shown that lymph node metastasis rates decrease as age increases, while in some, it decreases until a certain age and then increases. The reason for this has been interpreted in different ways, such as differences in tumor chronological age and inadequate screening programs in elderly patients. The role of predictive factors in this change is not fully known. Goal: Our aim is to evaluate the relationship between age and lymph node metastasis and to investigate the role of factors thought to be effective in metastasis in the biological behavior of tumors in different age groups. Material and Method: In our study, 150 patients who underwent breast-conserving surgery + sentinel lymph node biopsy, 71 patients who underwent breast-conserving surgery + sentinel lymph node biopsy conservative surgery + axillary lymph node dissection, 30 simple mastectomy + sentinel lymph node biopsy and 111 modified radical mastectomy total of 362 patients were selected, which was diagnosed with breast cancer in Ankara City Hospital General Surgery Clinic between March 2019 and February 2022, did not receive neoadjuvant treatment, did not have tumor continuity at the surgical margin and did not undergo re-excision. And the patients were divided into groups according to age, Lymph node metastasis, Tumor size, Notingham histological grade, Molecular Subgroups, HER2 positivity and overexpression, and ki-67 proliferation index . Then, metastasis rates were compared according to all ages and age groups in the subgroups of the criteria. Conclusion: We found that among the factors we looked at, tumor size, ki-67 index and histological grade were the most effective ages on metastasis, and the predictive significance of these factors was limited at early ages. A strong correlation was found between lymphovascular invasion and lymph node metastasis in all age groups, regardless of age. In addition, the effect of hormone receptor status on LNM was not significant in all patients and age groups. And age-related changes in lymph node metastasis rates for all patients were not statistically significant. Due to the fact that most of the factors we look at, including tumor size, are most effective on metastasis, and because the predictive values of these factors are limited at early ages, it will benefit more from the treatment protocols given based on these factors in older ages. We think that early diagnosis in breast cancers seen in older ages will reduce mortality more. Keywords: breast cancer, age, predictive factors, lymph node metastasis, tumor size, HER2, lymphovascular invasion, ki-67 proliferation index, histological grade, hormone receptor