THE NATURAL-HISTORY OF BREAST-CANCER WITH MORE THAN 10 POSITIVE NODES

BACKGROUND: Experimental protocols are being used increasingly to trea t breast cancer with >10 positive nodes, An appreciation of the natura l history of this disease is crucial for choosing the optimal therapeu tic approach, PATIENTS AND METHODS: We retrospectively reviewed the re cords of 141 patients who had breast cancer with >10 positive nodes an d received definitive therapy at our institution in the years 1969 thr ough 1991. Because therapy evolved during this period, we compared the results from 1969 through 1981 to those from 1982 through 1991. RESUL TS: Ninety-one patients (65%) were greater than or equal to 50 years o f age, Fifty-four (38%) were estrogen receptor (ER) positive, the rema inder were ER negative or ER status unknown, Fifty-seven (40%) had 10 to 15 positive nodes, 63 (45%) had 16 to 25, and 21 (15%) had >25. The ratio of positive nodes to total nodes was <50% in 22 patients, 50% t o 75% in 49, and >75% in 70. One hundred thirty-four patients (95%) un derwent modified or radical mastectomy, Forty (28%) received adjuvant chemotherapy, including 16 (11%) of 58 patients treated prior to 1981, Eleven patients (8%) were treated with adjuvant radiation therapy, Th e median survival for all patients was 52 months, with an actuarial su rvival of 29% at 10 years. Patients treated after 1981 had significant ly improved survival, They lived a median of 68 months postoperatively , as compared to 41 months among patients treated earlier, CONCLUSIONS : This is a high-risk group of patients, yet there is a small subset w ho can obtain a long survival with standard treatment modalities.