Local recurrence in breast carcinoma patients with T_1–2 and 1–3 positive nodes: Indications for radiotherapy

Abstract 

Aims

To investigate the relationship between local recurrence (LR) and distant recurrence (DR) and to determine a subgroup of patients who could benefit from radiotherapy among breast carcinoma patients with T_1–2 and N_1a.

Methods

Univariate and multivariate Cox regression analyses were carried out in the retrospective data of 326 eligible patients.

Results

Fourteen (4.3%) patients had LR and 46 (14.1%) patients suffered DR, in their follow-up periods. The multivariate time-dependent Cox model for DR showed that ratio of positive nodes (PN) (p=0.004; hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.02–1.09) and LR (p=0.05; HR, dependent on time) were strongly associated with DR. In the multivariate Cox analysis for LR, age (≤35 years vs >35 years; p<0.0001; HR, 6.8; CI, 2.3–19.9), lymphatic vascular invasion (LVI) (yes vs no; p=0.03; HR, 3.3; CI, 1.2–9.8), and a ratio of PN (>15% vs ≤15%; p<0.0001; HR, 13.0; CI, 3.9–42.0) were the most important prognostic factors. Whereas patients with 2 or 3 risk factors were accepted as the high risk group for LR, those with no or 1 risk factor were considered as the low risk group. These groups had a 23% LR rate and a 2.7% LR rate, respectively (p<0.0001).

Conclusions

This report confirmed the importance of local recurrence for distant recurrence. Age, ratio of PN and LVI were the most important prognostic factors for LR. The T_1–2 and N_1a patients who had 2 or 3 risk factors might benefit from radiotherapy.

Keywords: Breast carcinoma, 1–3 positive nodes, Prognosis, Ratio, Radiotherapy