| Background and purpose:Breast cancer is one of the most common malignant tumors in women.At present,the value of post-mastectomy radiotherapy(PMRT)for breast cancer patients with 1-3 positive nodes is controversial.Some scholars believe that PMRT can improve the local tumor control rate and bring survival benefits.While opponents argue that patients with breast cancer undergoing modern system treatment have a low risk of recurrence,and the effects of PMRT may outweigh the benefits.Therefore,in order to improve the survival benefit of patients without increasing the toxicity of radiotherapy,how to personalize the high-risk population of patients with 1 to 3 positive lymph nodes for radiotherapy has become a hot topic for scholars.This article retrospectively analyzes the clinical efficacy of PMRT for early breast cancer patients with one to three positive axillary lymph nodes.The clinical and pathological characteristics were used to further find the adverse factors affecting the prognosis of the patients,and to explore the value of PMRT in the subgroup with poor prognosis,so as to provide a reference for the application of PMRT in early breast cancer.Methods:A retrospective analysis was performed on the survival prognosis of 133 female breast cancer patients with stage T1-2 and one to three positive axillary lymph nodes after modified radical mastectomy who were admitted to the Department of Radiation Oncology of the First Affiliated Hospital of Bengbu Medical College from January 2011 to December 2016.The Cox proportional hazards model was used to determine the independent prognostic factors of the patients,and then the stratified analysis was performed based on the prognostic factors to study the effect of PMRT on the prognosis of patients with different high-risk subgroups.Results: The follow-up time ranged from 13 to 111 months,and the median follow-up time was 63 months.The 5-year LRR was 7.5%,the 5-year OS was 88.8%,and the 5-year DM was 13.8%.The 5-year LRR in PMRT group and non-PMRT group was 4.2% and 11.1%,respectively(P=0.062),the 5-year OS was 93.1% and 84.9%,respectively(P=0.157),and the 5-year DM was 8.8% and 17.9%,respectively(P=0.122),no statistical difference in survival between the two groups.Multivariate analysis showed that tumor size(P=0.046)、tri-negative type(P =0.001)and PMRT(P=0.035)were independent prognostic factors affecting LRR.The risk of LRR in non-PMRT was 5.508 times that in PMRT.Tumor size(P=0.014)and tri-negative type(P=0.002)were independent prognostic factors affecting OS.Group analysis of prognostic factors showed that PMRT reduced the local regional recurrence rate in patients with tumors ≥3 cm by 17.9%(4% and 21.9%,P=0.010),and improved overall survival by 21.4%(90.7% and 69.3%,P=0.039).However,in the tumors <3cm,tri-negative type and non-tri-negative type subgroups,radiotherapy did not bring significant survival benefits.Conclusion: For breast cancer with T1-2 stage and one to three positive lymph nodes,PMRT can reduce the risk of regional recurrence,but there is no survival benefit.Tumors ≥3 cm and tri-negative type are adverse factors for prognosis in patients with one to three positive lymph nodes.PMRT can significantly improve the prognosis of patients with tumors ≥3cm,but it has no obvious application value in patients with trinegative type. |
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