The Value Of Postmastectomy Radiotherapy For 1-3 Axillay Lymph Node-positive Stage ? Breast Cancer

Purpose:Breast cancer is one of the major malignant tumors that cause death in women worldwide.The treatment usually requires multidisciplinary collaboration.The standard treatment method is surgical resection of primary breast tumor and axillary lymph node dissection.Under the guidance of clinical pathology adjunctive treatments such as radiotherapy,chemotherapy,targeted therapy,and hormonal therapy are performed.Patients who undergo breast-conserving surgery are absolute indications for adjuvant radiotherapy.For patients undergoing modified radical surgery,the American Society of Clinical Oncology guidelines only recommend postoperative radiotherapy for breast cancer patients with T3(tumor diameter > 5 cm)or N2(more than 4 axillary lymph node metastases).In the National Comprehensive Cancer Network Guide of 2018,Stage ? patients with 1-3 axillary lymph node metastases(ie T1-2N1 breast cancer),postmastectomy radiotherapy is not a routine treatment.There are many breast cancer patients diagnosed with T1-2N1 in our country,they still receive postmastectomy radiotherapy,therefore,for patients with T1-2N1 breast cancer,there is a lot of controversy about postmastectomy radiotherapy.In this study,119 patients with T1-2N1 who underwent modified radical mastectomy in our hospital were selected.The survival parameters of postoperative radiotherapy group and non-radiation group were compared,and the risk factors of recurrence were investigated.The status of late side reaction caused by radiotherapy was analyzed.And also to identify the subgroup of poor prognosis in patients with T1-2N1 breast cancer.Materials and Method:Retrospective analysis of 119 patients with axillay lymph node-positive stage? breast cancer who underwent modified radical mastectomy in our hospital from March 2010 to March 2014.Systemic chemotherapy and/or endocrine therapy in allpatients.According to whether receive radiotherapy after surgery was divided into postmastectomy radiotherapy group(57 cases),non-radiotherapy group(62 cases).Calculate and analyze the 5-year overall survival,disease-free survival,local recurrence rate,and distant metastasis rate of the entire group of patients.Univariate and multivariate analysis were used to analyze the factors affecting prognosis and to find subgroups with poor prognosis.The status of late side reactions caused by radiotherapy is counted.Univariate analysis was performed by Kaplan-Meier method,and log-rank test was performed.Cox model was used for multivariate analysis.P<0.05 was considered statistically significant.Result:(1)The mean age of the patients was 51.52�8.84 years old,the age ranged from27 to 78 years old,and the median follow-up time was 62 months(12-108 months).After 5 years of follow-up,5 patients died,11 patients had local recurrence,and 11 patients had distant metastases.The 5-year overall survival rate,disease-free survival rate,local recurrence rate and distant metastasis rate of the whole group were 95.8%,86.6%,9.2%,9.2%,respectively.(2)The 5-year overall survival rates of patients with or without radiotherapy was 98.2% and 93.5%,respectively(P>0.05).The 5-year disease-free survival rate was 91.2% and 82.3%,respectively(P>0.05).The 5-year local recurrence rate was3.5% and 14.5%,respectively(P<0.05).The 5-year distant metastasis rate was 7.0%and 11.3%,respectively(P>0.05).(3)Log-rank univariate analysis showed that the number of axillary lymph node metastasis had a statistically significant difference in 5-year disease-free survival(P<0.05).The age,number of axillary lymph node metastasis,lymph node metastasis rate,histological grade,and radiotherapy had a significant difference in local recurrence rate were statistically significant(P<0.05).The other factors had no significant difference in the overall survival rate,disease-free survival rate,local recurrence rate and distant metastasis rate(P>0.05).(4)Cox multivariate analysis showed that age?40,radiotherapy and histology? were independent prognostic factors affecting 5-year local recurrence after modified radical mastectomy for T1-2N1 stage breast cancer.Conclusion:(1)The staged T1-2N1 breast cancer patients had a good overall prognosis aftermodified radical mastectomy.The 5-year overall survival rate was higher,and the local recurrence rate and distant metastasis rate were at a lower level.(2)Postmatectomy radiotherapy can reduce the local recurrence rate of 5 years for the staged T1-2N1 breast cancer,and has no significant effect on 5-year overall survival rate,disease-free survival rate and distant metastasis rate.(3)Age?40 years,histological grade ?,and non-radiotherapy group of patients with staged T1-2N1 breast cancer after modified radical mastectomy had a greater risk of local recurrence in 5 years.(4)Patients with radiotherapy after modified T1-2N1 breast cancer were well tolerated for side effect,and advanced adverse reactions were mainly grade 1,grade2 and above adverse reactions were rare.