Selection of Breast Cancer Patients for Adjuvant Chemotherapy Another Look at the Prognostic Importance of Involved Lymph Nodes

To aid in the selection of breast cancer patients for adjuvant chemother- apy, 263 patients with primary breast carcinoma undergoing curative surgery at the Yale-New Haven Medical Center were examined with respect to ax- illary lymph node involvement and prognosis. Thirty-five percent of patients with one to three axillary nodes histology- cally involved with cancer relapsed within five years, as did 61% of patients with four or more cancer-positive nodes. Equally important was the clinical stage. Stage III patients had a poor prognosis (71% relapse rate) regardless of their axillary status. Stage I patients with metastasis to one to three ax- illary nodes did just as well as stage I patients with no nodal involvement (13% relapse rate). Relapse rates within the nodal categories are signifi- cantly less (P < .05) than those reported by the National Surgical Adjuvant Breast Project. (JAMA 238:1034-1036, 1977)