Number of metastatic lymph node has a strong prognostic value in the course of breast cancer treatment, morbidity and even mortality. This study was undertaken to determine the association between axillary lymph node metastasis (ALNM) and several variables i.e. age, tumor size, grade, lympho-vascular invasion LVI, estrogen receptor(ER) and progesterone receptor (PR) expression and Her2/neu status.
Altogether 426 patients with complete information on study variables were analyzed. Incidence of nodal metastases was correlated with clinico-pathological factors, and analysed by univariate and multivariate analyses to ensure the independent predictors. Following information's of personal history were collected from the selected patients and 141 age matched normal women (control) as applicable: Age, age of menarche, marriage and 1st delivery, periods of lactation, age of menopause, type of cancer, duration of disease, treatment and diagnosis.
44.36% (189) of the patients had ALNM. We found that the tumor histology, Tumor size, grade and LVI were directly related with node positivity (p = 0.003, p = 0.004, p = 0.002, p < 0.0001 respectively). Age (p = 0.001), tumor grade (p = 0.003), tumor size (p = 0.001), lympho-vascular invasion (p = 0.02) and Her2/neu expression (p = 0.03) was significantly associated with the number of lymph node metastasis. The overall survival rate was poorer in node-positive cases, when compared with node-negative cases. Interestingly we found BRCA mutation are signiﬁcantly associated with Lymph node positivity. We also found tumor histology; grade, size and Her2/Neu over expression, menopausal status were significantly associated with ER/PR status. There was a signiﬁcant increase of the patients with menarche before 13 years of age (p < 0.01).
This study has been conducted for the first time among breast cancer patients in eastern India till date. Our study has demonstrated the significant association of age, tumor size, tumor grade, LVI and the histopathology with ALNM, which determine these independent predictive factors in the eastern Indian women for the presence of ALNM. Hence this information might be useful for individualized treatment.
Clinical trial identification
All authors have declared no conflicts of interest.