PREOPERATIVE CHEMOTHERAPY IN T3N0M0 (STAGE III) BREAST CANCER AND LYMPH NODE STATUS
Abstract:
Axillary dissection retains an essential role in breast cancer treatment. Preoperative chemotherapy has become the standard of cure for local advanced in breast cancer. The purpose of this study was to determine the effect of preoperative chemotherapy on the lymph nodes status after axillary dissection. Methods: We analysed 95 patients with stage T3N0 breast cancer treated between 2002 -2008 and who received combined preoperative chemotherapy. 55 patients received preoperative chemotherapy and postoperative chemotherapy and 40 patients only postoperative. In definitive surgical approach, all patients were made complete axillary lymph node dissection (levels I, II, III). Results: In the group with preoperative chemotherapy (CT), the number of histologically positive N +) lymph nodes was lower (average 0 vs. 3, p <0.1) and the extranodal extension was lower (18% vs. 43 % p = 0.2). In patients with preoperative chemotherapy, the univariate analysis showed that the extranodal dissemination(p <0.1), the number of pathologically positive lymph node (N+) (metastatic) (p <0.1) was predictive for survival of specific disease, but the multivariate analysis showed that only the extension extranodal was an independent prognostic factor in these cases (p <01). The overall 5 year survival in patients with chemotherapy compared between pre and post operatively was similar (66 % vs. 57 % p = 0.4). Patients with preoperative chemotherapy with 4-9 positive lymph nodes (N +) had a lower 5-year disease-free survival rate, compared with postoperative chemotherapy beneficiary group with 4-9 lymph nodes (17 % vs. 48 % p = 0.4). Conclusion: After preoperative chemotherapy the presence of pathologically positive lymph nodes was associated with a worse prognosis than the same nodal status before chemotherapy. Axillary lymph nodes status is a prognostic marker after chemotherapy.
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