| Purpose:To data mine, by the methods of multivariate statistics, on the clinical-pathological parameters and the result of systematic follow-up of the patient suffering invasive breast carcinoma, and to clarify the prognostic impact of these parameters on the survival of invasive breast cancer. We also intend to explored the prognostic impact of extra capsular extension (ECE) and positive-examined rate (PER) on maxillary lymph node involved invasive breast carcinoma and stratified analysis the impact by axillary lymph node status, and also to explored the different hazards proportion of the parameters and the interaction with protective factor, such as chemotherapy and radiotherapy, in different lymph node status.Materials and methods:We have established a huge data base as the result of systematic follow-up of1230patients with lymph node positive invasive breast carcinoma, who had admined in the Tianjin cancer hospital during1988to1995.By the method of data mining, we explored several significant prognostic factors besides TNM system, especially focusing on the impact of the ECE and PER on the survival data and the interaction of the implact posed by the risk factors, such as lymph node involved, ECE and PER, and the protective factors, such as chemotharapy and radiotharapy. In addition, we have tried to established a prognostic model by the method of decision tree, which was trained by1230cases of positive nodes invasive breast cancer and confirm by379partner with similar clinical scenarios.Result:Among the1230nodes positive breast cancer cases,486(39.5%) patients founded presented with ECE and598(48.6%) cases died. The median survival period is113.71months, while the5years overall survival rate is66.29%and the10years rate is55.28%. The patients who were41-50years old have the lowest ECE rate, and the patients younger than40years of older than50years have higher ECE rates. The ECE rates correlated with tumor size, the number of positive nodes, PER and the number of examined nodes. All of the factors are prognostic factors in the univariate Logistic regression analysis, while only tumor size, the number of positive nodes, PER are independent prognostic factors in the multivariate Logistic regression analysis, the number of examined nodes is not an independent prognostic factors. The ECE positive cases inclined to metastasis but more associated with no-viscera metastasis. ECE positive is risk factor for the non-chemotherapeutic patients. All of the patients could gain benefit from chemotherapy regardless of ECE status, but the ECE positives cases gained more. Despite this, the benefit from chemotherapy could not balance the risk from ECE. For the patients with1-3positive nodes, ECE has not a significant impact on overall survival, but has a significant impact when the patients have more than4positive nodes, the impact more significant in the4-9LNM cases. Stratified analysis according to the number of lymph nodes proved that ECE was not risk fact for overall survival in the LNM1-3patients, did not influenced the effect of the chemotherapy, and chemotherapy could balance the risk brought by ECE. On the contrary, in the LNM4-9patients ECE was risk fact for OS,ECE positive patients gained more benefit from chemotherapy, and chemotherapy could only reduce but not balance the risk brought by ECE completely. When the LNM≥10, ECE was not risk fact for OS, all of the ECE positive patients gained more benefit from chemotherapy, but the ECE negative cases gained more, and chemotherapy could only reduce but could not balance the risk brought by ECE completely. All of the patients could gain benefit from chemotherapy regardless of ECE status, but the ECE positives cases gained slightly more. The effect of chemotherapy was similar, and the protective impact from chemotherapy was stronger than the risk impact from ECE. Despite this, the overall prognoses of the patients in these two groups were not good. ECE positive is risk factor of local regional recurrence for all patients had not received radiotherapy. All of the patients could gain benefit from radiotherapy regardless of ECE status, the benefit from radiotherapy could not balance the recurrent risk from ECE. For the patients with1-3positive nodes, ECE has not a significant impact on local-regional failure free survival (LRFFS), but has a significant impact when the patients have more than4positive nodes, the impact more significant in the4-9LNM cases. Stratified analysis according to the number of lymph nodes proved that neither ECE nor radiotherapy was risk fact for LRFFS in the LNM1-3patients, all of the patients could not gain benefit from radiotherapy regardless of ECE status. On the contrary, in the LNM4-9patients ECE was risk fact for LRF, ECE positive patients gained more benefit from radiotherapy, and radiotherapy could balance the risk brought by ECE completely. When the LNM≥10, ECE was not risk fact for LRFFS, none of the ECE positive patients could gained more benefit from chemotherapy. ECE positive patients have less LRF rate because higher mortality rate, for, there were53-78.1%mortality without metastasis. The benefit of radiotherapy was limit for this group of patients. PER was a risk factor of overall patients (HR=1.724). The cutting-point is0.2for the patients with1-3positive nodes, while0.4for4-9positive nodes and0.6for LNM>10cases. The impacts of PERs were similar when adopted different cutting-point in different groups of patients. Stratified analysis according to the number of lymph nodes proved that PER>0.2was not risk fact for OS in the LNM1-3non-chemotherapy patients. Patients with PER>0.2gain benefit from chemotherapy, but the patients could not gain benefit from chemotherapy when the PER≤0.2. If receiving chemotherapy, the OS of patients with PER≤0.2shorter than those PER>0.2. PER>0.4was not risk fact for OS in the LNM4-9non-chemotherapy patients. All patients gained benefit from chemotherapy, while the patients gain less benefit from chemotherapy when the PER≤0.4. If receiving chemotherapy, the OS of patients with PER≤0.4shorter than those PER>0.4. PER>0.6was not risk fact for OS in the LNM≥10non-chemotherapy patients. Patients with PER<0.6gain more benefit from chemotherapy, while the patients could gain less benefit from chemotherapy when the PER≤0.6. If receiving chemotherapy, the OS of patients with PER>0.6shorter than those PER>0.6.In the decision tree algorithm, Tumor size was second main prognostic factor in the patients with1-3positive nodes after number of positive nodes, which was the first important prognostic factor. However, ECE was the second in the cases with4-9positive nodes and the PER for the LNM>10. We constructed a decision tree prognostic regression model for nodes positive breast cancer patients with the veracity is91.56%, which was significant higher than the algorithm of Logistic regression and Cox hazard proportion regression model.Conclusion:The impact of ECE contra-interacted with chemotherapy, but the ECE more influent than chemotherapy. The impacts of ECE were different according to the numbers of positive nodes. The chemotherapy has more impact than ECE for the patients with1-3positive nodes. ECE only reduced the OS in the patients with4-9positive nodes. All of the patients obtain equally benefit from chemotherapy, while the ECE positive patients gain more in4-9nodes patients and the ECE negative patients gain more if the patients have more than10positive nodes. The ECE relative dead evens increased according to the number of involved nodes. All of the patients could not beneficial from radiotherapy,1-3positive node is not the indication for radiotherapy. For the patients with4-9positive nodes, radiotherapy could balance the local-regional recurrence risk brought by ECE, ECE positive patients will gain more from radiotherapy. ECE was not recurrence risk factor for the patients with more than10positive nodes, because53-78.1%patients would dead before local recurrence, that mean the benefit of prophylactic radiotherapy was limited. However, in the patients needed radiotherapy for local-regional failure, the ECE was a significant risk factor (increasing4%recurrent rate). The result from the research suggested that it should adopt different cutting-points for different number of positive lymph-nodes. A higher PER was a risk factor for reducing overall survival. For the patients who died in the follow period and with a higher PER, the etiological factor were50%in all groups of patients, the patients with higher PER would obtain less from chemotherapy. The decision tree algorithm was more suitable prognostic model for the nodes positive patients, which have more heterogeneity, and was a single and practical prognostic model. |
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