HER2 Support Group Forums - View Single Post - # of lymph nodes involved no longer the marker bad prognosis it once was

Lani · 03-04-2008, 09:33 AM

Probably mainly applies to her2-s as they said those with over 10 lymph nodes and ER- had 12X as bad a prognosis as those with over 10 lymph nodes and ER+ and as 40-50% of ER-s are her2+ and more like 10% of ER+s are her2+ this may mainly reflect the much better than thought prognosis of er+her2-s with greater than 10 lymph nodes. I post this mainly to impress the importance of the new way of looking at prognosis based on molecular subtype rather than # of lymph nodes. Yes, it is always better within one molecular subtype not to have involved lymph nodes rather than to have many, but the subtype of bc may eclipse all that

ABSTRACT: An Update on Prognosis in Breast Cancer Patients with Extensive Axillary Disease
[The Breast Journal]
Lymph node (LN) status is the most important factor in predicting survival in breast cancer. Historically, patients with 10 or more positive LN have been thought to have a particularly poor prognosis, which has in the past been used to alter therapeutic recommendations. Studies conducted both prior to and after the use of anthracycline-based chemotherapy demonstrate poor survival. We hypothesized that the current survival rate is considerably higher. All patients with breast cancer treated at our institution between July 1991 and December 2005 with at least 10 positive axillary LN were identified. A multivariate Cox proportional hazards model was performed using age, number of positive nodes, and primary tumor characteristics. Of 55 patients identified, two were excluded for incomplete follow-up information. The median patient age was 53; median follow-up was 5-years. The overall 5-year survival rate was 71.9%. On univariate analysis estrogen receptor (ER) status (p = 0.0001), progesterone receptor status (p = 0.004), use of adjuvant chemotherapy (p = 0.01), T-stage (p = 0.03), and adjuvant hormonal therapy (p = 0.002) were statistically significant for survival. In the multivariate analysis, only ER status and the use of adjuvant chemotherapy remained significant for survival. ER negativity conferred a hazard ratio of 12.6 (95% confidence interval: 3.7-43.2) and the use of adjuvant chemotherapy had a hazard ratio of 0.14 (95% confidence interval: 0.04-0.46). In our study, patients with at least 10 positive axillary LN had a 5-year survival of 71.9% which may be due to the improvements in local and systemic therapy.

03-04-2008, 09:33 AM	#1
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	# of lymph nodes involved no longer the marker bad prognosis it once was Probably mainly applies to her2-s as they said those with over 10 lymph nodes and ER- had 12X as bad a prognosis as those with over 10 lymph nodes and ER+ and as 40-50% of ER-s are her2+ and more like 10% of ER+s are her2+ this may mainly reflect the much better than thought prognosis of er+her2-s with greater than 10 lymph nodes. I post this mainly to impress the importance of the new way of looking at prognosis based on molecular subtype rather than # of lymph nodes. Yes, it is always better within one molecular subtype not to have involved lymph nodes rather than to have many, but the subtype of bc may eclipse all that ABSTRACT: An Update on Prognosis in Breast Cancer Patients with Extensive Axillary Disease [The Breast Journal] Lymph node (LN) status is the most important factor in predicting survival in breast cancer. Historically, patients with 10 or more positive LN have been thought to have a particularly poor prognosis, which has in the past been used to alter therapeutic recommendations. Studies conducted both prior to and after the use of anthracycline-based chemotherapy demonstrate poor survival. We hypothesized that the current survival rate is considerably higher. All patients with breast cancer treated at our institution between July 1991 and December 2005 with at least 10 positive axillary LN were identified. A multivariate Cox proportional hazards model was performed using age, number of positive nodes, and primary tumor characteristics. Of 55 patients identified, two were excluded for incomplete follow-up information. The median patient age was 53; median follow-up was 5-years. The overall 5-year survival rate was 71.9%. On univariate analysis estrogen receptor (ER) status (p = 0.0001), progesterone receptor status (p = 0.004), use of adjuvant chemotherapy (p = 0.01), T-stage (p = 0.03), and adjuvant hormonal therapy (p = 0.002) were statistically significant for survival. In the multivariate analysis, only ER status and the use of adjuvant chemotherapy remained significant for survival. ER negativity conferred a hazard ratio of 12.6 (95% confidence interval: 3.7-43.2) and the use of adjuvant chemotherapy had a hazard ratio of 0.14 (95% confidence interval: 0.04-0.46). In our study, patients with at least 10 positive axillary LN had a 5-year survival of 71.9% which may be due to the improvements in local and systemic therapy.