title: Influence of lymphatic invasion on locoregional recurrence following mastectomy: indication for postmastectomy radiotherapy for breast cancer patients with one to three positive nodes.
abstract: OBJECTIVE
  The indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status.
  
  
  METHODS
  Retrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status.
  
  
  RESULTS
  Multivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295).
  
  
  CONCLUSIONS
  Among postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.
authors.affiliation: Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. r-matsunuma@nifty.com
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Matsunuma
authors.forename: Masahiko
authors.initials: M
authors.lastname: Oguchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Fujikane
authors.forename: Masaaki
authors.initials: M
authors.lastname: Matsuura
authors.forename: Takehiko
authors.initials: T
authors.lastname: Sakai
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Kimura
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Morizono
authors.forename: Kotaro
authors.initials: K
authors.lastname: Iijima
authors.forename: Ayumi
authors.initials: A
authors.lastname: Izumori
authors.forename: Yumi
authors.initials: Y
authors.lastname: Miyagi
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Nishimura
authors.forename: Masujiro
authors.initials: M
authors.lastname: Makita
authors.forename: Naoya
authors.initials: N
authors.lastname: Gomi
authors.forename: Rie
authors.initials: R
authors.lastname: Horii
authors.forename: Futoshi
authors.initials: F
authors.lastname: Akiyama
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwase
mesh_terms: D000367:Age Factors; D001365:Axilla; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000737:chemistry / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011184:Postoperative Period; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone