J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 The Korean Surgical Society 10.4174/jkss.2009.77.4.238 Original Article Prognostic Factors Influence on the Systemic Recurrence in Axillary Lymph Node Negative Breast Cancer Lee Hee Seung M.D. Kwak Beom Seok M.D. Son Byung Ho M.D. 1 Ahn Sei Hyun M.D. 1 Department of Surgery, Dongguk University, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea. Corresponding author (kbs@duih.org) 10 2009 30 09 2009 77 4 238 245 05 06 2009 23 07 2009 Copyright © 2009 The Korean Surgical Society 2009 Purpose

Axillary lymph node metastasis is one of the most important prognostic factors in breast cancer. Previous reports show differences that clinicopathologic factors influence the systemic recurrence and survival in axillary lymph node negative breast cancer. Thus, we have attempted to determine the prognostic factors influence on the systemic recurrence and survival in axillary lymph node negative breast cancer.

 Methods

We retrospectively reviewed the data of 1,351 node negative breast cancer patients who underwent curative surgery to determine the prognostic factors such as age, sex, body mass index (BMI), family history, bilateral breast cancer, operation method, tumor size, stage, histologic grade, number of resected lymph nodes, hormone receptor status, overexpression of p53 and c-erbB2, and adjuvant therapy that influence the systemic recurrence and 10-year-distant relapse-free survival.

 Results

Systemic recurrence occurred in 58 patients (4.3%) during 53.3 months median follow up period. The tumor size (P=0.001), stage (P=0.005), histologic grade (P=0.049). ER (P=0.028), PR (P=0.002), overexpression of p53 (P=0.001) and bilateral breast cancer (P=0.043) were statistically significant factors that influenced the systemic recurrence. In multivariate analysis, only tumor size was associated with the systemic recurrence (P=0.003). Tumor size (P=0.004), histologic grade (P=0.035), ER (P=0.046), PR (P=0.001) and bilateral cancer (P=0.003) were statistically significant factors that influenced 10-year-distant relapse-free survival.

 Conclusion

The larger tumor size was determined to be an independent prognostic value in axillary lymph node negative breast cancer.

 Axillary lymph node negative breast cancer Systemic recurrence Prognostic factor Ministry for Heath, Welfare and Family Affairs Annual Report of Cancer Incidence (2005) and Survival (1993~2005) in Korea 2008 20 23 The Korean Breast Cancer Society Nationwide Korean breast cancer of 2004 using breast canser registration program J Breast Cancer 2006 9 151 161 Son BH Ahn SH Kwak BS Kim JK Kim HJ Hong SJ The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer J Breast Cancer 2006 9 134 144 Kuru B Camlibel M Gulcelik MA Alagol H Prognostic factors affecting survival and disease-free survival in lymph node-negative breast carcinomas J Surg Oncol 2003 83 167 172 Goldhirsch A Wood WC Gelber RD Coates AS Thurlimann B Senn HJ Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007 Ann Oncol 2007 18 1133 1144 McGinnis LS Menck HR Eyre HJ Bland KI Scott-Conner CE Morrow M National Cancer Data Base survey of breast cancer management for patients from low income zip codes Cancer 2000 88 933 945 Adair F Berg J Joubert L Robbins GF Long-term followup of breast cancer patients: the 30-year report Cancer 1974 33 1145 1150 Giordano SH Buzdar AU Hortobagyi GN Breast cancer in men Ann Intern Med 2002 137 678 687 Jemal A Siegel R Ward E Murray T Xu J Thun MJ Cancer statistics, 2007 CA Cancer J Clin 2007 57 43 66 Min YK Kim NR Cho SJ Kim A Bae JW Koo BH The clinical significance and prognosis of Korean young age (younger or 35 year old) onset breast cancer J Korean Breast Cancer Soc 2001 4 74 79 Park SH Kim SI Park BW Lee KS Prognostic factors in axillary lymph node negative breast cancer J Korean Breast Cancer Soc 2004 7 111 120 Christian MC McCabe MS Korn EL Abrams JS Kaplan RS Friedman MA The National Cancer Institute audit of the National Surgical Adjuvant Breast and Bowel Project Protocol B-06 N Engl J Med 1995 333 1469 1474 van der Hage JA Putter H Bonnema J Bartelink H Therasse P van de Velde CJ Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis Eur J Cancer 2003 39 2192 2199 Kute TE Russell GB Zbieranski N Long R Johnston S Williams H Prognostic markers in node-negative breast cancer: a prospective study Cytometry B Clin Cytom 2004 59 24 31 Younes M Laucirica R Lack of prognostic significance of histological grade in node-negative invasive breast carcinoma Clin Cancer Res 1997 3 601 604 Baak JP Colpaert CG van Diest PJ Janssen E van Diermen B Albernaz E Multivariate prognostic evaluation of the mitotic activity index and fibrotic focus in node-negative invasive breast cancers Eur J Cancer 2005 41 2093 2101 Amadori D Silvestrini R Prognostic and predictive value of thymidine labelling index in breast cancer Breast Cancer Res Treat 1998 51 267 281 Ma H Bernstein L Pike MC Ursin G Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies Breast Cancer Res 2006 8 R43 Dunnwald LK Rossing MA Li CI Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients Breast Cancer Res 2007 9 R6 van der Wal BC Butzelaar RM van der Meij S Boermeester MA Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage I and II breast cancer Eur J Surg Oncol 2002 28 481 489 Weir L Speers C D'Yachkova Y Olivotto IA Prognostic significance of the number of axillary lymph nodes removed in patients with node-negative breast cancer J Clin Oncol 2002 20 1793 1799 Barnes DM Dublin EA Fisher CJ Levison DA Millis RR Immunohistochemical detection of p53 protein in mammary carcinoma: an important new independent indicator of prognosis? Hum Pathol 1993 24 469 476 Choi NK Kim SY Kim TY Chae MK Baek MJ Lim CW clinical correlation of c-erbB-2, p53, bcl-2, and c-myc expression in patients with breast cancer J Korean Surg Soc 2002 62 371 380 Jobsen JJ van der Palen J Ong F Meerwaldt JH Synchronous, bilateral breast cancer: prognostic value and incidence Breast 2003 12 83 88 Kroenke CH Chen WY Rosner B Holmes MD Weight, weight gain, and survival after breast cancer diagnosis J Clin Oncol 2005 23 1370 1378 Loi S Milne RL Friedlander ML McCredie MR Giles GG Hopper JL Obesity and outcomes in premenopausal and postmenopausal breast cancer Cancer Epidemiol Biomarkers Prev 2005 14 1686 1691 Whittemore AS Stearman B Venne V Halpern J Felberg A McGuire V No evidence of familial correlation in breast cancer metastasis Breast Cancer Res Treat Epub 2009 Mar 19

10-year-distant relapse-free survival according to tumor size (A), histologic grade (B), estrogen receptor (C), progesterone receptor (D), p53 overexpression (E), and bilateral breast cancer (F).

Systemic recurrence according to the clinicopathologic factors

*BCS = breast conserving surgery; †BMI = body mass index.

Multivariate analysis of risk factors for systemic recurrence