Abstract
We retrospectively analyzed clinicopathologic features and survival in breast cancer patients who had T1 or T2 primary tumours and 1-3 histologically involved axillary lymph nodes and who were treated with modified radical mastectomy without adjuvant radiotherapy (rt). We also explored prognosis to find the high- and low-risk groups. From May 2001 to April 2005, 368 patients treated at Tianjin Tumor Hospital met the study criteria. The 5- and 8-year rates were 7.2% and 10.7% for locoregional recurrence (lrr), 85.1% and 77.7% for disease-free survival (dfs), and 92.8% and 89.3% for overall survival (os). Multivariate Cox regression analysis showed that age, tumour size, estrogen receptor (er) status, and lymphovascular invasion (lvi) were independent prognostic factors for lrr and dfs. Based on 4 patient-related factors that indicate poor prognosis (age < 40 years, tumour > 3 cm, er negativity, and lvi), the high-risk group (patients with 3 or 4 factors, accounting for 12.5% of the cohort) had 5- and 8-year rates of 24.3% and 36.9% for lrr, 57.2% and 39.2% for dfs, and 74.8% and 43.8% for os compared with 5.0% and 7.1% for lrr, 88.9% and 83.1% for dfs, 91.6% and 83.4% for os in the low-risk group (patients with 0-2 factors, accounting for 87.5% of the cohort; p < 0.001). Our study identified several risk factors that correlated independently with a greater incidence of lrr and distant metastasis in patients with T1 and T2 breast cancer and 1-3 positive nodes. Patients with 0-2 risk factors may not be likely to benefit from post-mastectomy rt, but patients with 3-4 risk factors may need rt to optimize locoregional control and improve survival.
Highlights
Modified radical mastectomy is an important treatment for a significant number of patients with breast cancer, especially for those with more diffuse local disease[1]
Patients with 0–2 risk factors may not be likely to benefit from post-mastectomy rt, but patients with 3–4 risk factors may need rt to optimize locoregional control and improve survival
The roles of adjuvant chemotherapy and hormonal treatment in prolonging survival have been established in numerous randomized trials[2], and the addition of radiotherapy after definitive mastectomy and systemic chemotherapy was demonstrated to improve locoregional control and overall survival in patients who have high-risk breast cancer
Summary
Modified radical mastectomy (mrm) is an important treatment for a significant number of patients with breast cancer, especially for those with more diffuse local disease[1]. The roles of adjuvant chemotherapy and hormonal treatment in prolonging survival have been established in numerous randomized trials[2], and the addition of radiotherapy (rt) after definitive mastectomy and systemic chemotherapy was demonstrated to improve locoregional control and overall survival in patients who have high-risk breast cancer. The role of pmrt in patients with tumours 5 cm or less in size and 1–3 positive nodes has not been widely accepted, and the long-term effect on overall survival (os) of local tumour control improved by adjuvant pmrt continues to be debated. The answer awaits the results of future randomized trials[5]
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