title: Postoperative fever: the potential relationship with prognosis in node negative breast cancer patients.
abstract: BACKGROUND
  Postoperative fever may serve as an indirect sign to reflect the alterations of the host milieu caused by surgery. It still remains open to investigation whether postoperative fever has a bearing on prognosis in patients with lymph node negative breast cancers.
  
  
  METHODS
  We performed a retrospective study of 883 female unilateral patients with lymph node negative breast cancer. Fever was defined as an oral temperature ≥38 in one week postoperation. Survival curves were performed with Kaplan-Meier method, and annual relapse hazard was estimated by hazard function.
  
  
  RESULTS
  The fever patients were older than those without fever (P<0.0001). Hypertensive patients had a propensity for fever after surgery (P = 0.011). A statistically significant difference was yielded in the incidence of fever among HR+/ERBB2-, ERBB2+, HR-/ERBB2- subgroups (P = 0.012). In the univariate survival analysis, we observed postoperative fever patients were more likely to recur than those without fever (P = 0.0027). The Cox proportional hazards regression analysis showed that postoperative fever (P = 0.044, RR = 1.89, 95%CI 1.02-3.52) as well as the HR/ERBB2 subgroups (P = 0.013, HR = 1.60, 95%CI 1.09-2.31) was an independent prognostic factor for relapse-free survival.
  
  
  CONCLUSIONS
  Postoperative fever may contribute to relapse in node negative breast cancer patients, which suggests that changes in host milieu related to fever might accelerate the growth of micro-metastatic foci. It may be more precise to integrate both tumor- and host-related factors for the evaluation of relapse risk.
authors.affiliation: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Yan
authors.forename: Wenjin
authors.initials: W
authors.lastname: Yin
authors.forename: Liheng
authors.initials: L
authors.lastname: Zhou
authors.forename: Yiwei
authors.initials: Y
authors.lastname: Jiang
authors.forename: Zhenzhou
authors.initials: Z
authors.lastname: Shen
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Shao
authors.forename: Jinsong
authors.initials: J
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005334:Fever / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension; D007150:Immunohistochemistry / Q000379:methods; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome