Clinical significance of locoregional and systemic treatment in operable high-risk breast cancer patients with more than four positive axillary lymph nodes

Figures & data

Table 1 Demographic and disease characteristics of eligible patients

Characteristics	Patients with 4–6 ALNs (n=198)	Patients with ≥7 ALNs (n=320)	P-value
Age, years, n (%)			0.821
≤35	12 (6.0)	24 (7.5)
>35, ≤50	96 (48.5)	152 (47.5)
>50	90 (45.5)	144 (45)
Tumor size, n (%)			<0.0001
T ≤2 cm	45 (22.7)	38 (11.9)
2 cm < T ≤5 cm	128 (64.6)	198 (61.9)
T > 5 cm	25 (12.6)	84 (26.3)
Estrogen-receptor status, n (%)			0.794
Positive	103 (52.0)	169 (52.8)
Negative	75 (37.9)	117 (36.6)
Unknown	20 (10.1)	34 (10.6)
Progesterone-receptor status, n (%)			0.132
Positive	99 (50)	141 (44.1)
Negative	75 (37.9)	143 (44.7)
Unknown	24 (12.1)	36 (11.2)
HER2 status, n (%)			0.105
Positive	58 (29.3)	114 (35.6)
Negative	119 (60.1)	169 (52.8)
Unknown	21 (10.6)	37 (11.6)
Surgery type, n (%)			<0.0001
Modified radical mastectomy	76 (38.4)	70 (21.9)
Radical/extended radical mastectomy	122 (61.6)	250 (78.1)
Chemotherapy regimen, n (%)			0.109
CA(E)F/CA(E)F > T	118 (59.6)	206 (64.4)
CMF	66 (33.3)	92 (28.8)
No chemotherapy	12 (6.1)	11 (3.4)
Unknown	2 (1.0)	11 (3.4)
Radiotherapy, n (%)			0.04
Yes	89 (45.0)	116 (36.3)
No	93 (47.0)	179 (55.9)
Unknown	16 (8.0)	25 (7.8)

Abbreviations: CA(E)F, fluorouracil/doxorubicin (epirubicin)/cyclophosphamide; CA(E)F > T, CA(E)F followed by docetaxel; CMF, cyclophosphamide/methotrexate/fluorouracil; ALNs, axillary lymph nodes.

Figure 1 Survival analysis and subgroup analysis for patients with different axillary lymph node (ALN) status and tumor size.

Notes: Kaplan–Meier estimates of (A) disease-free survival and (B) overall survival for patients with different ALN status; Kaplan–Meier estimates of (C) disease-free survival and (D) overall survival for patients with different tumor sizes.

Figure 2 Survival analysis and subgroup analysis for patients with different hormone-receptor status.

Notes: Kaplan–Meier estimates of (A) disease-free survival and (B) overall survival for patients with different estrogen receptor (ER) status, and (C) disease-free survival and (D) overall survival for patients with different progesterone receptor (PR) status.

Figure 3 Survival analysis and subgroup analysis for patients undergoing different types of surgery.

Notes: Kaplan–Meier estimates of (A) disease-free survival and (B) overall survival for patients with seven or more axillary lymph nodes (ALNs).

Figure 4 Survival analysis and subgroup analysis for patients with or without radiotherapy.

Notes: Kaplan–Meier estimates of (A) disease-free survival for all patients and (B) disease-free survival for patients with seven or more ALNs involved with or without radiotherapy.

Figure 5 Survival analysis and subgroup analysis for patients receiving different chemotherapy regimens.

Notes: Kaplan–Meier estimates of (A) disease-free survival and (B) overall survival for all patients, (C) ALN disease-free survival and (D) overall survival for patients with seven or more ALNs involved receiving different chemotherapy regimens.
Abbreviations: CA(E)F, fluorouracil/doxorubicin (epirubicin)/cyclophosphamide; CA(E)F > T, CA(E)F followed by docetaxel; CMF, cyclophosphamide/methotrexate/fluorouracil.

Table 2 Multivariate Cox proportional hazard regression analyses for DFS and OS in eligible patients

Variable	DFS			OS
	HR	95% CI	P-value	HR	95% CI	P-value
Age	0.75	0.55–1.01	0.058	0.80	0.51–1.24	0.314
Number of ALNs involved	2.00	1.31–3.05	0.001	2.96	1.51–5.77	0.002
Tumor size	1.48	1.06–2.08	0.022	2.32	1.38–3.89	0.001
Hormone-receptor status	0.88	0.58–1.32	0.529	0.82	0.45–1.46	0.495
Type of surgery	0.47	0.30–0.74	0.001	0.39	0.20–0.76	0.006
Radiotherapy	0.72	0.49–1.05	0.086	0.89	0.51–1.55	0.687
Chemotherapy regimen	0.87	0.72–1.05	0.151	0.64	0.50–0.85	0.002

Abbreviations: DFS, disease-free survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; ALNs, axillary lymph nodes.