To establish a risk scoring system for predicting locoregional recurrence (LRR) and explore the potential value of radiotherapy in T1 to T2 node-negative breast cancer patients treated with mastectomy. From January 2001 to February 2008, a total of 353 node-negative T1 to T2 breast cancer cases treated with mastectomy without adjuvant radiotherapy were retrospectively analyzed. Preliminary screening of the prognostic factors was accomplished by Kaplan-Meier univariate analysis, and survival curves between different groups were compared by log-rank test. Risk factors were determined using Cox proportional hazards model. A categorical risk scoring system was generated according to the Cox model, weighing the relative importance of each risk variable. Median follow-up was 115.7 months (range, 1.2-238.4 months). The overall 5-year locoregional recurrence-free survival (LRFS) was 89.8% (95% confidence interval [CI] = 86.7%-92.9%). Chest wall (53.8%) was found to be the most common site of LRR, followed by supraclavicular nodes (48.7%). Age ≤40 years, primary tumor size ≥4.5 cm and number of nodes resected ≤10 were found to be independent factors for poor prognosis of LRR. Two risk stratifications based on the scoring system were subsequently obtained. The 5-year LRFS was 91.6% (95% CI = 88.5%-94.7%) with low risk (score <2) and 75.7% (95% CI = 61.8%-89.6%) with high risk (score ≥2), respectively (χ = 7.544, P = .006). In addition, significant differences in overall survival (P = .045) and disease-free survival (P = .019) were presented between them. Patients with T1-2N0M0 breast cancer achieved favorable prognosis in general. Those with risk factors, including age ≤40 years, primary tumor size ≥4.5 cm and number of nodes resected ≤10, were at higher risk of LRR. The established scoring system could help to distinguish the subgroups that might potentially benefit from postoperative radiotherapy.

译文

建立预测局部复发 (LRR) 的风险评分系统,并探讨放疗在接受乳房切除术的T1至T2淋巴结阴性乳腺癌患者中的潜在价值。回顾性分析2001年1月至2008年2月353例T1至T2淋巴结阴性的乳腺癌患者,行乳房切除术而不进行辅助放疗。通过Kaplan-Meier单因素分析完成了对预后因素的初步筛选,并通过log-rank检验比较了不同组之间的生存曲线。使用Cox比例风险模型确定危险因素。根据Cox模型生成了分类风险评分系统,并权衡了每个风险变量的相对重要性。中位随访时间为115.7个月 (范围为1.2-238.4个月)。总体5年无局部复发生存率 (LRFS) 为89.8% (95% 置信区间 [CI]  =   86.7%-92.9%)。胸壁 (53.8%) 是LRR最常见的部位,其次是锁骨上淋巴结 (48.7%)。年龄 ≤ 40岁、原发肿瘤大小 ≥ 4.5  cm、切除淋巴结数目 ≤ 10是LRR预后不良的独立因素。随后获得了基于评分系统的两个风险分层。5年LRFS为91.6% (95% ci   =   88.5%-94.7%) 的低风险 (得分 <2) 和75.7% (95% ci   =   61.8%-89.6%) 的高风险 (得分 ≥ 2) (χ  =   7.544,p   =  .006)。此外,两者之间的总生存期 (p   =  .045) 和无病生存期 (p   =  .019) 存在显着差异。T1-2N0M0乳腺癌患者总体上获得了良好的预后。具有危险因素 (包括年龄 ≤ 40岁,原发肿瘤大小 ≥ 4.5  cm和切除的淋巴结数目 ≤ 10) 的患者发生LRR的风险较高。建立的评分系统可以帮助区分可能从术后放疗中受益的亚组。

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