OBJECTIVETo analyse the clinical features and prognostic factors of small breast cancer patient (T < or =2 cm) with multiple axillary lymph node metastasis (N > or =4).

METHODSThe data of 118 small breast cancer patients (T < or =2 cm) with multiple axillary lymph node metastasis (N > or =4) surgically treated from 1993 to 2003 were retrospectively analysed by SPSS 13.0 software.

RESULTSThe overall 5-year survival rate was 75.0% in this series. It was found by single-variant Kaplan-Merier analysis that the stage, adjuvant chemotherapy and adjuvant endocrine therapy significantly influenced the outcome of the patients. For patients with 4-9 or > or =10 metastatic axillary lymph nodes, the 5-year OS was 89.5% and 59.8%, respectively (P = 0.009). It was 82.1% and 53.3% in the patients with or without adjuvant chemotherapy (P = 0.001), respectively. For patients with or without adjuvant endocrine therapy, the 5-year OS was 89.2% and 61.9% (P = 0.001). Multi-variant Cox regression analysis showed that the stage, adjuvant chemotherapy and adjuvant endocrine therapy were independent prognostic factors.

CONCLUSIONSmall breast cancer with multiple axillary lymph node metastasis usually has a tendency of metastasis with a poor prognosis, especially in those with > or =10 metastatic axillary lymph nodes. The stage, adjuvant chemotherapy and adjuvant endocrinetherapy were independent prognostic factors. Reasonable multi-modality therapy may be able to improve the outcome of these patients.