Analysis Of Locoregional Recurrence Factors In Early Breast Cancer (T_1-2N₁M₀) After Modified Radical Mastectomy And Potential Value Of Radiotherapy

Objective:To analyze retrospectively the prognosis between receiving postmastectomy radiation therapy?PMRT?and not receiving PMRT for T_1-2 breast cancer patients with 1³ positive axillary nodes after modified radical mastectomy.And seek for poor prognosis subgroup through analyzing clinical factors which affect locoregional recurrence.And compare the breast cancer related lymphedema of the two groups.Materials and methods:Retrospectively analyzed T_1-2 breast cancer patients with 1³positive axillary nodes from March 2009 to March 2013,who experienced modified radical mastectomy in the second affiliated hospital of jilin university.Patients were chosen according to the criteria.The vast majority of patients received chemotherapy and?or?endocrinotherapy.Among all the selected patients,60 patients experienced PMRT,and 78patients did not experience PMRT.Study of 5-year overall survival?OS?,disease-free survival?DFS?,local recurrence?LRR?and distant metastasis?DM?of all patients.Univariate analysis and multivariate analysis were carried out to analyze the factors that affect locoregional recurrence for seeking for high risk factors.The univariate analysis was implemented by Kaplan-Meier,the comparisons between groups by Log-rank test and the multivariate analysis implemented by Cox regression model.P<0.05 was considered statistically significant.Results:?1?The median age was 50 years old?25⁷4 years old?.The median follow-up time was 62.5 months?6¹05 months?and 138 patient was selected until the end of the follow-up.Among all patients,13 cases died,10 cases occurred local recurrence and 13 cases occurred distant metastasis.The 5-year OS,DFS,LRR and DM for entire cohort were90.6%,87.0%,7.2%and 9.4%,respectively.?2?The comparison between PMRT and not PMRT showed that the OS of two groups was 96.7%and 85.9%?P>0.05?respectively,DFS was90.0%and 84.6%?P>0.05?respectively,LRR was 3.3%and 10.3%?P>0.05?respectively and DM was 9.3%and 10.3%?P>0.05?respectively.PMRT had no impact on OS,DFS,LRR and DM.?3?The comparison of the upper limb edema between PMRT and not PMRT showed that there were 18?30.0%?cases occurring edema among PMRT and 12?15.4%?cases occurring edema among not PMRT.In order to compare the differences between the two groups,chi-square test was conducted.The result showed that there was a statistical difference between the two groups?P<0.05?.?4?The univariate analysis was used to analyze the clinical factors affecting LRR.The result showed that age?P<0.05?,menstrual status?P<0.05?and histological grade?P<0.05?were factors that affect postmastectomy LRR.?5?The Cox multi-factor model for multivariate analysis showed:age?P<0.05?and histological grade?P<0.05?were independent prognostic factors for LRR.Conclusions:?1?Early-stage breast cancer of T_1-2N₁M₀ has good OS and low locoregional recurrence after modified radical mastectomy.?2?According to the results from the entire group T_1-2N₁M₀early-stage breast cancer patients,PMRT has no significant effect on OS,DFS,LRR and DM.?3?PMRT can increase the incidence of edema in patients with lateral upper extremity.?4?The LRR increases in the subgroup of age no more than 40 years old and histological grade III.PMRT may benefit them better,so weighing the risks and benefits of radiotherapy for this stage patients is necessary.