Abstract
BackgroundPostoperative fever may serve as an indirect sign to reflect the alterations of the host milieu caused by surgery. It still remains open to investigation whether postoperative fever has a bearing on prognosis in patients with lymph node negative breast cancers.MethodsWe performed a retrospective study of 883 female unilateral patients with lymph node negative breast cancer. Fever was defined as an oral temperature ≥38 in one week postoperation. Survival curves were performed with Kaplan-Meier method, and annual relapse hazard was estimated by hazard function.FindingsThe fever patients were older than those without fever (P<0.0001). Hypertensive patients had a propensity for fever after surgery (P = 0.011). A statistically significant difference was yielded in the incidence of fever among HR+/ERBB2-, ERBB2+, HR-/ERBB2- subgroups (P = 0.012). In the univariate survival analysis, we observed postoperative fever patients were more likely to recur than those without fever (P = 0.0027). The Cox proportional hazards regression analysis showed that postoperative fever (P = 0.044, RR = 1.89, 95%CI 1.02–3.52) as well as the HR/ERBB2 subgroups (P = 0.013, HR = 1.60, 95%CI 1.09–2.31) was an independent prognostic factor for relapse-free survival.ConclusionPostoperative fever may contribute to relapse in node negative breast cancer patients, which suggests that changes in host milieu related to fever might accelerate the growth of micro-metastatic foci. It may be more precise to integrate both tumor- and host-related factors for the evaluation of relapse risk.
Highlights
Worldwide, more than a million women are diagnosed with breast cancer every year, accounting for 27% of all female new cases in the United States in 2009 [1]
Postoperative fever may contribute to relapse in node negative breast cancer patients, which suggests that changes in host milieu related to fever might accelerate the growth of micro-metastatic foci
The development of imaging techniques contributed to the increased diagnosis of earlier breast cancer patients, most of whom were featured by negative axillary lymph node (ALN) [3,4,5]
Summary
More than a million women are diagnosed with breast cancer every year, accounting for 27% of all female new cases in the United States in 2009 [1]. The development of imaging techniques contributed to the increased diagnosis of earlier breast cancer patients, most of whom were featured by negative axillary lymph node (ALN) [3,4,5]. Women with ALN negative breast cancers have a relatively good prognosis. The 21-gene Recurrence Score (RS) assay (Oncotype DX, Genomic Health, Redwood city, CA) is one of the best tools along with the pathology to help quantify the risk of distant recurrence as well as predict the magnitude of chemotherapy benefit in tamoxifen-treated patients with lymph node-negative, estrogen receptor(ER)-positive breast cancer [11,13,14]. It still remains open to investigation whether postoperative fever has a bearing on prognosis in patients with lymph node negative breast cancers
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