Long-term outcome of breast cancer patients with pathologic N3a lymph node stage

Breast. 2017 Apr;32:79-86. doi: 10.1016/j.breast.2016.12.018. Epub 2017 Jan 5.


Purpose: To evaluate factors influencing the long-term outcome of patients presenting with 10 or more metastatic axillary lymph nodes (pN3a) after surgery for primary breast cancer.

Method: Between January 1990 and December 2015, a total of 130 patients with pN3a breast cancer at surgery were identified in our Institutions and included in the study. Twenty-nine of them (22.3%) received neoadjuvant chemotherapy. The Multivariate Cox proportional hazards model was used to determine independent prognostic factors associated with DFS and OS.

Results: After a median follow-up of 6.4 years (range 0.87-25 years), 2 patients had a local relapse, 59 distant metastases (1 with local relapse) and 52 patients died. The 5-year DFS and OS rates were 61.8% and 71.5%, respectively. At multivariate analysis, pN3a stage after neoadjuvant chemotherapy (ypN3a) was significantly associated with increased risk of recurrence (HR 1.92, p = 0.02) and death (HR 2.05, p = 0.029). Absence of progesterone receptor (PR) expression was the most important tumor characteristic associated with poor prognosis, both in terms of recurrence (HR 2.55, p < 0.001) and death (HR 2.23, p = 0.019). High levels of Ki-67 index (≥20%) were significantly associated with a shorter OS (HR 2.03, p = 0.027), but not with DFS.

Conclusions: The results of this study indicate that ypN3a stage, lack of expression of PR, and Ki-67 ≥ 20% negatively affect long-term outcome of patients with pN3a breast cancer.

Keywords: Breast cancer; Ki-67; Progesterone Receptor; Prognosis; Stage pN3a.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Italy
  • Ki-67 Antigen / analysis
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Proportional Hazards Models
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Retrospective Studies
  • Survival Rate
  • Time Factors


  • Ki-67 Antigen
  • Receptors, Estrogen
  • Receptors, Progesterone