| Objective:Breast cancer is one of the most common malignant tumors in female patients.And the impact of tumor location on the prognosis of breast cancer patients is still controversial.The purpose of this study is to investigate the effect of tumor location on the prognosis of patients with axillary lymph node negative breast cancer.Methods:We collected the medical records of 277 patients who were initially diagnosed in Affilicated Hospital of Guilin Medical University and underwent modified radical mastectomy or simple mastectomy+axillary sentinel lymph node biopsy from September 2009 to May 2015,including gender,age,tumor location,TNM stage,molecular typing,etc.,and screened out those who met the conditions of negative axillary lymph node,with complete pathological and immunohistochemical results and follow-up data and other conditions.Telephone follow-up was performed according to the medical record,and the survival status was recorded,and the follow-up results were collated.Kaplan-meier univariate analysis was used,survival differences were tested by log-rank,and Cox regression was used for multivariate analysis.P<0.05 was statistically significant.Results:This study included 277 patients with postoperatively negative ALN who underwent modified radical mastectomy or simple mastectomy+axillary sentinel lymph node biopsy in Affilicated Hospital of Guilin Medical University(24 patients of death,8.66%;28 patients with recurrence,10.11%).The median follow-up period was 67 months(5-108 months),including 3 male patients(1.08%)and 274 female patients(98.92%);the median age was 49 years old(25～92 years old),13 patients aged<35 years old(4.7%)and 264 patients aged≥35 years old(95.3%);other information was as follows:159 patients with external tumor location(57.40%),118 patients with internal tumor location(42.60%);156 patients of stageⅠ(56.32%),121 cases of stageⅡ(43.68%);114 patients with Lumina A typing(41.16%),51 patients with Lumina B typing,47 patients with negative ER,PR and Her-2,65 patients with postiive HER-2(23.47%);28 patients with recurrence(10.11%),including 24 patients of death(8.66%),5-years DFS of 89.89%and 5-years OS of 93.14%.In the single-factor analysis,the differences in age,tumor location,TNM staging,overall survival(OS)and disease-free survival(DFS)of molecular typing and grouping were statistically significant by log-tank test(age grouping DFS:χ~2=6.987,P=0.008,OS:χ~2=9.275,P=0.002;tumor location grouping DFS:χ~2=6.044,P=0.014,OS:χ~2=6.066,P=0.014;TNM stage grouping DFS:χ~2=9.651,P=0.002,OS:χ~2=7.575,P=0.006;molecular type grouping DFS:χ~2=16.707,P=0.001,OS:χ~2=14.615,P=0.002).The variable with statistically significance was included into Cox regression for test,which indicated that internal tumor location,TNM staging II,negative ER,PR and Her-2 and positive Her-2 are independent factors to DFS and OS of patients with breast cancer concurrent with negative ALN.Conclusions:Tumor located medially is an independent influencing factor for the prognosis of axillary lymph node negative breast cancer patients.This effect may be due to the omission of IMLN during treatment.Therefore,it is recommended that patients with axillary lymph node-negative breast cancer whose tumor is located on the inside should perform IM-SLNB.If the pathological results of the lymph nodes are positive and the medical technology and the tolerance of the patient allow,IMLN dissection+radiotherapy(chest-wall+regional lymph node radiotherapy including intermammary)should be performed;if it has been confirmed that the IMLN has metastasized but lymphatic dissection cannot be performed,the radiotherapy(chest-wall+regional lymph node radiotherapy including intermammary)is still required. |
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