The Effect Of Paget’s Disease On Axillary Lymph Node Metastasis And Prognosis In Invasive Ductal Breast Cancer

Objective: This study was designed to investigate the status of axillary lymph node metastasis(ALN)and survival in patients with invasive ductal carcinoma with Paget disease(PD-IDC),and to further analyze the factors affecting the prognosis of patients with PD-IDC.Methods: The clinicopathological data of 392 patients in PD-IDC in Tianjin Tumor Hospital from January 1,2006 to December 31,2012 were collected.A matched control group contains 392 patients with simple infiltrating ductal carcinoma(IDC)according to the three variables: diagnostic age,histologic subtype and tumor size.Univariate and multivariate Logistic regression analysis was conducted on variables that may affect the status of axillary lymph nodes of IDC.Kaplan-Meier survival curve and Cox proportional risk regression were used to compare the disease-free survival and overall survival of PD-IDC and the IDC group,and further analyze the influence of clinical tumor on the prognosis of PD-IDC.Results:Among the 392 patients with PD-IDC,202(51.5%)had axillary lymph node metastasis,which was associated with age(p=0.000),histological grade(p=0.000),pathological type(p=0.000),T stage(p=0.000)and molecular typing(p=0.000).Multivariate analysis showed that PD-IDC had a higher risk of axillary lymph node metastasis(OR=2.897,p=0.000),which was an independent predictor of ALN metastasis.The follow-up time was 9-194 months,and the median follow-up time was 85 months.Kaplan-Meier survival curve analysis showed that compared with the control group,the DFS and OS of the PD-IDC group were poor(DFS: p=0.000,OS: p=0.042).Multivariate Cox regression analysis showed that PD was an independent factor affecting the prognosis of PD-IDC(p= 0.032).Furthermore,The DFS and OS of 392 PD-IDC with clinical masses was worse than that of the group without clinical masses,and the difference was statistically significant among(DFS: p=0.004;OS: p= 0.006)Multivariate Cox regression analysis showed that clinical masses were independent factors affecting DFS OS of PD-IDC(DFS: OR=1.044,95%CI 0.702-1.553,p=0.032;OS:OR = 1.122,95% CI 0.736 1.711,p= 0.042).Conclusion: The risk of axillary lymph node metastasis in PD-IDC is increased and the prognosis is poor.PD is an independent factor affecting the prognosis and axillary lymph node metastasis.Furthermore,the prognosis of PD-IDC with clinical masses is poor.The main symptoms of clinical manifestations may be an effective indicator of prognosis in PD-IDC.