PROGNOSTIC VALUE OF LYMPH-NODE METASTASES AFTER NEOADJUVANT CHEMOTHERAPY FOR LARGE-SIZED OPERABLE CARCINOMA OF THE BREAST

BACKGROUND: Neoadjuvant chemotherapy followed by surgery or radiation therapy, or both, has become the treatment of choice for patients with large-sized resectable carcinoma of the breast in whom mastectomy is the conventional option, Since tumor regression before surgery is cons idered a favorable prognostic factor, there is still controversy regar ding the need to perform an axillary dissection after a good response to systemic induction treatment. STUDY DESIGN: Between February 1990 a nd December 1993, we conducted a prospective study of 56 consecutive p atients receiving high-dose anthracycline-based preoperative chemother apy for large but potentially resectable carcinoma of the breast, Pati ents who had a good clinical response to induction systemic treatment received the same chemotherapy in the adjuvant phase, while those whos e response was less than optimal received alternative adjuvant chemoth erapy regimens, A multivariate analysis was made to evaluate the relat ive influence on disease-free survival rates of 11 clinicopathologic a nd treatment-related variables, including clinical response to primary chemotherapy, primary pathological (p-T) staging, and the number of m etastatic lymph nodes. RESULTS: At a median follow-up period of 36 mon ths, only the number of metastatic lymph nodes was found to be an inde pendent predictor of relapse, Clinical response to systemic induction treatment and p-T staging did not correlate with prognosis, In the gro up of patients with axillary lymph node involvement, those who did not respond to preoperative chemotherapy showed a lower relapse rate comp ared with those who achieved an objective response. CONCLUSIONS: These findings suggest that axillary lymphadenectomy should be considered a n important component of the combined modality therapy for patients wi th large-sized resectable carcinoma of the breast in order to identify subgroups of patients that may benefit from alternative treatments in the adjuvant setting.