Clinical significance of locoregional and systemic treatment in operable high-risk breast cancer patients with more than four positive axillary lymph nodes.

To investigate further the effect of therapeutic approaches on patients with worse prognoses, we performed subgroup analysis, which clarified that the type of surgery conferred better DFS in the seven or more ALN subgroup ( P =0.0305, Figure 3A ), and this analysis also showed an OS benefit of marginal significance ( P =0.0547, Figure 3B ).

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Progesterone receptor status was also associated with OS ( P =0.0107, Figure 2D ), whereas estrogen receptor status conferred an OS benefit with marginal significance ( P =0.0580, Figure 2B ).

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The significant difference for DFS was almost completely generated by the seven or more ALN subgroup ( P =0.0107, Figure 4B ), whereas the four to six ALN subgroup did not reach statistical significance ( P =0.3344, data not shown).

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Subgroup analysis showed the importance of level III ALND for the seven or more involved ALN subgroup as well, which presented better DFS and a marginally significant improvement in OS.

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