The Value Of The Local Recurrence Factors In Determining The Radiation Therapy Indications For Early Breast Cancer With1～3Positive Axillary Nodes

objective:To define the subgroups of patients at high risk of recurrence who might gain benefit from postmastectomy radiotherapy for early breast cancer with1-3positive axillary nodes.Method and Materials:Between December2002and March2008,175women of early breast cancer received modified/radical mastectomy with1～3involved axillary nodes in xiangya hospital. The vast majority of patients received systemic therapy, and76cases were treated with postmastectomy local/regional radiotherapy (PMRT) whereas the others not. The survival was account by Kaplan-Meier and the comparisons between groups by Log-rank test.The multivariate analysis using Cox regression model. Inspection level of alpha(a) equal to0.05.Result:(1) all patients followed up until March2013, the median follow-up time was83months,5cases fail to follow-up.(2) The5-year overall survival (OS) and5years disease-free survival (DFS)、5years local recurrence (LRR) and5years distant metastasis rate (DM) for entire cohort were89.1%,84.6%,8.0%and12.0%, respectively; The5-year OS, DFS, LRR and DM with and without PMRT were93.4%vs85.9%(P=0.110),89.5%vs80.8%(P=0.122),5.3%vs11.1%(P=0.168),7.9%vs15.2%(P=0.142) respectively.(3)Age≤40y and ALNMR≥20%were risk factors for LRR in the multivariate analysis;(4) for the subgroup with age≤40y,5-year LRR of the patients with or without PMRT were7.4%.30.0%respectively (χ2=3.960, P=0.047),5-year DFS were88.9%、65.0%respectively (χ2=3.864, P=0.046),5-year OS were96.3%.75.0%respectively (χ2=4.401, P=0.041); for the subgroup with ALNMR≥20%,5-year LRR of the patients with or without PMRT were5.9%、33.3%respectively (χ2=4.117, P=0.042),5-year DFS were88.2%、58.3%respectively (χ2=4.099, P=0.043),5-year OS were94.1%、70.8%respectively (χ2=3.442, P=0.064)Conclusion:1) The outcome for the entire group of patients was satisfactory overall, which not recommending routine postoperative radiotherapy for early breast cancer with1-3positive lymphnodes; Age≤40years and the ALNMR≥20%were the independent risk predictors for5-year LRR and the two subgroups can be strongly considered postoperative radiotherapy;2) for the subgroup with age≤40y, PMRT significantly reduced5-year LRR, improved5-year DFS and5-year OS; for the subgroup with ALNMR≥20%, PMRT significantly reduced5-year LRR, improved5-year DFS and has potential benefit in OS, which suggested that postoperative radiatherapy is feasible.