Pathological lymph node involvement at surgery is a significant predictive factor of recurrence in locally advanced breast cancer treated with concomitant epirubicin-docetaxel neoadjuvant chemotherapy: a cohort study

Background Neoadjuvant chemotherapy (NAC) is the standard therapy for locally advanced breast cancer. Recently, several studies have revealed that clearance of axillary lymph node involvement is an independent factor for survival irrespective of the response of the primary lesion. However, in daily practice, it is difficult to fully examine every lymph node that has been surgically sampled, in view of pathology laboratory workload and cost. Therefore, in the present study, we adopted the more clinically relevant categorization of evaluating postoperative axillary lymph node status and retrospectively studied its significance in predicting patients' survival. Methods The study cohort consisted of 35 locally advanced breast cancer patients who are treated with concomitant epirubicin-docetaxel. The clinicopathological factors used for analysis were as follows: ER alpha, PgR, p53, HER2, pathological response (in the primary tumor), and axillary lymph node status at surgery. With regard to axillary lymph node status, we categorized patients into two groups: those with pathological lymph node involvement at surgery (pLNI) and those without. Using multivariate analysis, we evaluated the significance of these factors in predicting disease-free survival after surgery. Results The median follow-up period was 23.4 months (range 4.3-45.4). Multivariate analysis showed significantly reduced disease-free survival associated with pLNI (P = 0.005). Conclusions pLNI is an excellent prognostic factor for locally advanced breast cancer patients treated with concomitant epirubicin-docetaxel. Use of our criteria may enable large numbers of oncologists to participate in new studies of high-risk cohorts who are refractory to NAC.