Journal List > J Breast Cancer > v.13(2) > 1036197

Lee, Kim, Suh, and Shim: Predictors of 4 or More Positive Axillary Nodes in Patients with Nodepositive T1-2 Breast Carcinoma: The Indications for Adjuvant Irradiation of the Level III Axilla and Supraclavicular Fossa

Abstract

Purpose

We evaluate the predictors of 4 or more involved axillary nodes in patients with node-positive T1-2 breast carcinoma to select a group of patients who are indicated for adjuvant irradiation of the level III axilla and supraclavicular fossa (SCF).

Methods

We analyzed 286 patients with positive axillary nodes and who were without distant metastases and who underwent breast conserving surgery and axillary lymph node dissection or modified radical mastectomy. We investigated the relationship between the patients and the tumor factors and 4 or more positive axillary nodes.

Results

On the multivariate logistic-regression analysis, an increased tumor size (p=0.002), the presence of lymphovascular space invasion (LVSI) (p<0.001) and a palpable mass p<0.001) were positively associated with involvement of 4 or more axillary lymph nodes. In our study, 86.1% of the patients with all the unfavorable factors had involvement of 4 or more nodal metastases.

Conclusion

Our data suggest that for patients with node-positive T1-2 breast cancer, the presence of 4 or more involved nodes is frequently observed for the patients with an increased tumor size, the presence of LVSI and a palpable mass at the time of diagnosis, and we recommend that they undergo irradiation of the high axilla and SCF for adjuvant care, if they do not undergo complete axillary dissection.

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Fig 1.
It shows the receiver operating curve (ROC) that corresponds to the multiple logistic model we applied to our data set of 286 patients. The area under the ROC is 0.80 (p<0.001; 95% CI, 0.742-0.858), which indicates the potentially promising predictive power of the multivariate logistic-regression model.
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Table 1.
Patient and tumor characteristics (n=286)
Characteristic No. %
Age groups (yr)
 0-50 158 55.2
 >50 128 44.8
Tumor size (mm)
 T1a (0-5.0) 14 4.9
 T1b (5.1-10) 19 6.6
 T1c (10.1-20.0) 73 25.6
 T2 (20.1-50.0) 180 62.9
Histologic grade
 1 20 7.0
 2 67 23.4
 3 83 29.0
 Unknown 116 40.6
Lymphovascular invasion
 Negative 138 48.2
 Positive 106 37.1
 Unknown 42 14.7
ER status
 Negative 112 39.2
 Positive 169 59.1
 Unknown 5 1.7
PR status
 Negative 111 38.8
 Positive 170 59.5
 Unknown 5 1.7
HER2 status
 Negative 156 54.6
 Positive 125 43.7
 Unknown 5 1.7
EGFR status
 Negative 140 49.0
 Positive 23 8.0
 Unknown 123 43.0
Tumor calcification
 Negative 86 30.1
 Positive 109 38.1
 Unknown 91 31.8
Palpable mass
 Negative 60 21.0
 Positive 226 79.0

ER=estrogen receptor; PR=progesterone receptor; HER2=human epidermal growth factor receptor 2; EGFR=epidermal growth factor receptor 1.

Table 2.
Involvement of 4 or more axillary nodes with regard to the patient and tumor characteristics
Characteristic Four or more involved nodes % p-value
Age groups (yr) 0.140
 0-50 78/158 49.4
 >50 52/128 40.6
Tumor size (cm) <0.001
 T1 (≤2) 22/106 20.8
 T2 (>2, ≤5) 108/180 60.0
Histologic grade 0.404
 1 8/20 40.0
 2 38/67 56.7
 3 42/83 50.6
Lymphovascular invasion <0.001
 Negative 44/138 31.9
 Positive 78/106 73.6
ER status 0.663
 Negative 52/112 46.4
 Positive 74/169 43.8
PR status 0.044
 Negative 58/111 52.3
 Positive 68/170 40.0
HER2 status 0.144
 Negative 76/156 47.7
 Positive 50/125 40.0
EGFR status 0.752
 Negative 78/140 55.7
 Positive 12/23 52.2
Tumor calcification 0.102
 Negative 48/86 55.8
 Positive 48/109 44.0
Palpable mass <0.001
 Negative 12/60 20.0
 Positive 118/226 52.2

ER=estrogen receptor; PR=progesterone receptor; HER2=human epidermal growth factor receptor 2; EGFR=epidermal growth factor receptor 1.

Table 3.
Univariate logistic-regression analysis for factors associated with involvement of 4 or more axillary nodes
Variable Unadjusted odds ratio (95% of confidence interval) p-value
Tumor size (cm)
 T1 (≤2) 1.00 (referent)
 T2 (>2, ≤5) 5.72 (3.28-9.98) <0.001
Lymphovascular invasion
 Negative 1.00 (referent)
 Positive 5.95 (3.39-10.42) <0.001
PR status
 Negative 1.00 (referent)
 Positive 0.60 (0.37-0.98) 0.037
Palpable mass
 Negative 1.00 (referent)
 Positive 4.37 (2.20-8.66) <0.001

ER=estrogen receptor; PR=progesterone receptor.

Table 4.
Multivariate logistic-regression analysis for factors associated with involvement of 4 or more axillary nodes
Variable Adjuated odds ratio (95% of confidence interval) p-value
Tumor size (cm)
 T1 (≤2) 1.00 (referent)
 T2 (>2, ≤5) 2.91 (1.52-5.57) 0.001
LVSI
 Negative 1.00 (referent)
 Positive 4.70 (2.58-8.57) <0.001
Palpable mass
 Negative 1.00 (referent)
 Positive 5.01 (2.19-11.45) <0.001

LVSI=lymphovascular space invasion.

Table 5.
Involvement of 4 or more axillary nodes with regard to the combinations of the significant factors identified on the multivariate analysis
Characteristic Four or more involved nodes %
No LVSI, nonpalpable, T1 mass 2/20 10.0
No LVSI, nonpalpable, T2 mass 4/23 21.1
No LVSI, palpable, T1 mass 13/49 17.4
No LVSI, palpable, T2 mass 14/33 42.4
LVSI, nonpalpable, T1 mass 0/3 0
LVSI, nonpalpable, T2 mass 5/19 26.3
LVSI, palpable, T1 mass 9/18 50.0
LVSI, palpable, T2 mass 68/79 86.1

LVSI=lymphovascular space invasion.

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