Node-positive disease

Lymph node involvement. Patients with node-positive disease have a worse prognosis. 

Survival benefit for adjuvant chemotherapy in stage I and II breast cancer is modest. The absolute reduction in mortality at 10 years is 5% in nodenegative and 10% in node-positive disease. 

For decades the standard treatment approach for muscle-invasive disease has been a radical cystectomy. This therapy provides excellent local control with relatively few pelvic recurrences (1). Aggressive surgical intervention also provides a significant cure rate, with an overall 5-yr survival for organ-confined disease of 65%, while those with extravesical extension 40% and for those with lymph-node positive disease 15% (1-6). Over the past several decades, radical cystectomy has become a much safer procedure,... 

Direct randomized comparisons unfortunately are very rare. However, the two Stockholm breast cancer trials in women treated with modified radical mastectomy provide a comparison of postoperative radiotherapy and chemotherapy with a median follow-up of 18 years (Rutqvist and Johansson 2006). All patients had node-positive disease or a tumor diameter exceeding 30 mm. The radiation dose was 46 Gy in 2-Gy fractions to the chest wall, axilla, supraclavicular fossa, and the ipsilateral internal mammary nodes. Ghemotherapy initially consisted of 12 cycles (later 6 cycles) of cyclophosphamide 100 mg/m orally on days 1-14, methotrexate 40 mg/m i.v. on days 1 and 8, and 5-fiuorouracil 600 mg/m i.v. on days 1 and 8 (CMF). In the trial that included premenopausal patients, 291 were allocated to CMF and 256 to radiotherapy. In each arm, 12% were node negative. Sixty-two and 64% were estrogen-receptor positive, respectively. Locoregional recurrence was observed in 14% after radiotherapy and 24% after chemotherapy (hazard ratio 0.67, p = 0.048). The absolute benefit increased with the number of positive lymph nodes. As might be expected, fewer patients developed distant recurrence after CMF and the eventual difference in breast cancer deaths was 50% versus 56%. This... 

The addition of taxanes, docetaxel and paditaxel, a newer class of agents, to adjuvant regimens comprised of the drugs listed above resulted in consistently and significantly improved disease-free survival and OS in node-positive breast cancer patients. 

Modest advances have been seen with the application of chemotherapy to stage 3 (lymph node positive) NSCLC. A few patients with unresectable stage 3A disease can be rendered resectable by chemoradiation using concurrent radiation and cisplatin based therapy. Those who remain unresectable and those with stage 3B disease achieve an approximate 3 month prolongation of overall survival and... 

Breast cancer cytosols Immunoassay Overexpressed in younger patients with early-stage disease, small ER - positive, low S-phase, low-cellularity diploid tumors Associated with a longer DFS and OSc Independent indicator of increased DFS for all patients as well as node-positive, ER-negative Favorable prognosis [269]... 

Serum levels of pi 05 are most useful in breast cancer with some use in ovarian cancer patients. pl05 levels in breast cancer correlate with a worse prognosis and a shorter disease-free state. Elevated HER-2/ ew levels also correlate with larger tumor size, lymph node positivity, and high grading score. HER-2/ eu serum levels are not only to be used for prognosis, but may be used to guide treatment. One study of 719 breast cancer patients showed that elevated levels of... 

The taxanes (paclitaxel and docetaxel) are a newer class of agents that rival the anthracyclines in their activity in metastatic breast cancer, becoming (arguably) the most active class of chemotherapy for this disease. Since these agents are relatively new, adjuvant studies including them have not yet been incorporated into the overview metaanalysis. However, results from a few clinical trials have been reported and are reaching substantial follow-up to provide meaningful information. All trials have enrolled node-positive patients only, and all... 

Hormone receptors may also be useful as prognostic indicators, particularly in node positive patients. The prognostic role in node negative patients is minimal. In node positive patients the hormone receptor positive patients seem to have a better prognosis for both disease-free and overall survival (Nl). It has been observed that the measurement of the actual concentration of receptor is important in evaluation of survival (S4). 

It has been suggested (KIO) that the role of ERP in a better prognosis with respect to disease-free and overall survival is confined to subjects with positive axillary node involvement at the time of initial presentation. In node negative disease, the differences in prognoses are minimal if any. PRP status also has been associated with increased survival in node negative disease. However, recent data from patients with negative nodes who received adjuvant chemotherapy demonstrated no relationship between ERP status and disease-free survival. Therefore receptor status in node negative disease probably should not be used as either a... 

Whether surgery and radiotherapy are equally effective in smaU-volume disease is difficult to judge as very few direct randomized comparisons with sufficient sample size have been published. One of the best examples is probably the French trial comparing 658 breast cancer patients with clinically uninvolved lymph nodes, which were treated with lumpectomy plus axillary dissection or axillary radiotherapy (Louis-Sylvestre et al. 2004). In the group with dissected axilla, 21% of the patients were node positive. The median follow-up was 180 months. 

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