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Japanese Journal of Clinical Oncology 2005 35(9):514-519; doi:10.1093/jjco/hyi143
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© 2005 Foundation for Promotion of Cancer Research

Identifying Good Prognosis Group of Breast Cancer Patients with 1–3 Positive Axillary Nodes for Adjuvant Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) Chemotherapy

Yung-Chang Lin1, Shin-Cheh Chen2, Hsien-Kun Chang1, Swei Hsueh3, Chien-Sheng Tsai4, Yung-Feng Lo2, Tsann-Long Hwang2 and Miin-Fu Chen2

1 Division of Hematology/Oncology, Department of Internal Medicine, 2 Department of Surgery, 3 Department of Pathology and 4 Department of Radiation Oncology, Breast Cancer Study Group, Cancer Center, Chang Gung Memorial Hospital, Taipei, Taiwan

For reprints and all correspondence: Shin-Cheh Chen, Department of surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei 105, Taiwan. E-mail: chensc{at}adm.cgmh.org.tw

Received December 15, 2004; accepted June 30, 2005

Objective: We conducted a retrospective analysis of prognosis factors for survival in breast cancer patients with 1–3 axillary lymph node metastases and tried to identify a subset of patients with good prognosis suitable for cyclophosphamide, methotrexate and 5-fluorouracil (CMF) adjuvant chemotherapy.

Methods: A cohort of 446 breast cancer patients received definite surgery and adjuvant chemotherapy with CMF at Chang Gung Memorial Hospital from 1990 to 1998. They were enrolled in the study. The median follow-up time was 69 months. Prognostic factors including age, tumor size, number of involved nodes, steroid receptor status, tumor ploidy, synthetic-phase fraction, histologic grade and administration of tamoxifen were analysed for disease-free survival (DFS) and overall survival (OS) by Cox regression model.

Results: The estimated 5 year OS and DFS for all patients were 85.4 and 71.5%, respectively. Multivariate analysis revealed that tumor size, age and estrogen receptor (ER) status were independent prognostic factors for OS, and tumor size, age, ER status and number of involved nodes were independent prognostic factors for DFS. The 5 year OS rates of the low-risk group (age >40, tumor ≤3 cm and positive ER) and average-risk group (either age ≤40, tumor >3 cm or negative ER) were 98.8 and 82.4%, respectively (P = 0.0001). The 5 year DFS of the low-risk and high-risk group were 88.2 and 67.7%, respectively (P = 0.0001).

Conclusion: Among breast cancer patients with 1–3 positive lymph nodes excellent survival rate was found in those who had favorable prognostic factors, including age >40, tumor size ≤3 cm and positive ER. Adjuvant chemotherapy with CMF regimen is optimal for these low-risk patients.

Key Words: breast cancer • lymph node metastasis • adjuvant chemotherapy • prognostic factors


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