256 Prognostic factors of survival and recurrence of paget’s disease of the breast: a study of 58 cases

Objectives To investigate clinical features, prognostic factors and survival outcomes of mammary Paget’s disease (PD). Methods A retrospective study based on 58 patients with histological verified PD treated at the Salah Azaiez Institute between 2001 and 2012. Results The mean age was 54.78 years.Palpable masses were recorded in 74.1% of cases with a mean size of 52.21 mm.All patients underwent radical mammectomy associated to axillary lymph node dissection (LND) in 96.6% of cases and sentinel LND in two cases.PD was isolated (IPD) in 5 cases (8.6%), and associated to invasive carcinoma (IC) in 42 (72.4%), to microinvasion in 4 cases (6.9%) and intraductal carcinoma (IDC) in 7 cases (12.1%).High grade IC accounted for 57.1%.Negative hormone receptor (HR) were recorded 48.3% of cases and lymph node metastasis (LNM) in 58.6%.Adjuvant chemotherapy and radiotherapy were indicated in 58.6% of cases and hormonal therapy in 56.9% of cases. After a median follow up of 45.5 months, 41.4% of patients presented with relapses and 44.8% died from their disease. The 5 years overall survival (OS) was 51.9% and the 5 years recurrence free survival (RFS) was 57.4%.The 5 years OS and RFS were significantly decreased in case of associated IC (39.5% and 35.7%) compared to IPD and associated IDC (100% and 100%) and microinvasion (50% and 66.7%) (p=0.023). LNM, lymph node ratio (LNR) exceeding 70%, advanced T stage and palpable mass were significantly correlated to worse OS and RFS. Conclusions Palpable mass, tumor stage and LNM were significantly associated with poor prognosis in PD of the breast.