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Purpose: Larger tumor size and more extensive lymph node (LN) involvement have been considered independent factors for poor prognosis of breast cancer. We evaluated whether smaller tumor size may be a factor of worse prognosis compared with larger tumor size in smallsized breast cancer with LN involvement. Methods: A retrospective analysis was conducted at a single center for 1,400 patients with smallsized (≤2 cm) and LN involved (N1−N3) breast cancer who underwent radical surgery, had no distant metastases, and were diagnosed between 2004 and 2014. We subdivided their tumor size into four subgroups (T1mi, T1a, T1b, T1c) graded using the 7th American Joint Committee on Cancer staging and two subgroups (T1ab [≤1 cm] and T1c [>1 cm]) divided by tumor size. The relationship between tumor size, prognosis and specific features were analyzed using the Chi-square test, Kaplan-Meier method, and Cox regression analysis. Results: There were significant differences in estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2) and HER2 amplified type among the four subgroups in all patients. Especially, HER2-amplified type also appeared in distribution significantly between the two subgroups in all patients (T1ab [13.0%] vs. T1c [8.0%], p=0.008). The overall survival of the T1N1 staged patients in the smaller-sized tumor group (T1ab) was lower than that of those in the larger-sized group (T1c) (p=0.005). In the multivariate Cox regression analysis of all patients, the T1ab group showed a higher mortality risk compared with the T1c group (adjusted hazard ratio, 2.540; 95% confidence interval, 1.195–5.397; p=0.015). Conclusion: Smaller-sized tumors with LN involvement indicated worse prognosis compared with larger-sized tumors.

Comparison of Prognosis according to Tumor Size in Small Breast Cancer with Lymph Node Involvement