Prognostic analysis of survival in small XXXX .

@entity1 @entity2917 @entity0 @entity5 @entity13712 @entity3
BACKGROUND: Routine axillary dissection in @entity1 with @entity0 remains controversial. We previously reported a model for predicting @entity2917 in @entity1 with @entity13712 or T1b @entity0 that may guide the practice of selective nodal dissection. The objective of this study was to determine whether the prognosticators that predict nodal @entity3 also predict survival. STUDY DESIGN: This study is a retrospective review of 2,153 @entity1 with @entity0 (< or = 1 cm) diagnosed between January 1984 and December 1995. Cases were identified from a statewide @entity5 registry, the Hospital Association of Rhode Island, and the @entity5 registry at Baystate Medical Center in Massachusetts. The impact on survival of @entity1 age (< or = 40 versus > 40 years), nodal status (positive versus negative), @entity5 size ( @entity13712 versus T1b), and @entity5 grade (1 versus 2 or 3) were analyzed. @entity0 -specific survival (BCSS) was analyzed using the Kaplan-Meier method and the proportional hazards regression method. RESULTS: There were 388 @entity1 with @entity5 0.5 cm or less ( @entity13712 ) and 1,765 with @entity5 0.6-1.0 cm (T1b). Nodal status was known in 68% of cases (1,461 of 2,153), and @entity5 grade was recorded in 42% of cases (902 of 2,153). In univariate analysis, age, grade, and nodal status were significant in their association with BCSS. @entity5 size did not influence BCSS among @entity1 with small invasive @entity5 . @entity1 older than 40 years had superior survival compared with younger @entity1 (93% versus 78% at 5 years; p = 0.01). Similarly, @entity1 with low grade (1) @entity5 did better than those with higher grade (2 or 3) @entity5 (98% versus 88% at 5 years; p = 0.03). The 5-year BCSS was 96% versus 78% for node-negative versus node-positive disease, and the 10-year BCSS was 91% versus 62% (p = 0.001). In the multivariate analysis, age and nodal status remained firmly associated with survival, although grade lost its significance. CONCLUSIONS: Small @entity5 size does not affect survival. Although risk profiles for @entity2917 can be constructed to help guide the practice of selective axillary lymphadenectomy in @entity1 with small invasive @entity0 , these factors cannot serve as a surrogate to nodal status in establishing @entity1 prognosis. Nodal status remains the most powerful determinant of survival in @entity0 @entity1 , even those with very small @entity5 .
