Radiotherapy and Survival in Node Positive Breast Cancer
Radiotherapy and Survival in Node Positive Breast Cancer
In the W region, 15% (225/1490) of the patients with one to three positive nodes had postmastectomy radiotherapy and 87% (1099/1260) of the patients who underwent breast-conserving surgery and had one to three positive nodes received breast radiotherapy. The corresponding figures for patients with one to three positive nodes in the SE region were 89% (905/1012) for postmastectomy radiotherapy and 96% (657/686) for breast and regional radiotherapy after breast-conserving surgery. The median number of examined lymph nodes among patients with one to three positive nodes was 13 in the W region and ten in the SE region. The distribution of lymph nodes examined is shown in Figure 2. The use of adjuvant endocrine therapy was similar between the regions: W region, 54% (1482/2750) and SE region, 60% (1021/1698). Adjuvant chemotherapy was slightly more common in the W region, 42% (1167/2750) compared with 25% (421/1698) in the SE region.
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Figure 2.
Distribution of number of axillary lymph nodes analyzed in patients with one to three positive nodes in the west (n = 2750) and southeast (n = 1698) regions.
The relative survival of patients with one to three positive lymph nodes in the two regions was similar (Figure 3). The 10-year relative survival was 78% in the W region and 77% in the SE region (P = 0.12), Separating the relative survival analyses for patients with mastectomy and those with breast-conserving surgery resulted in similar results for the two regions (Figure 4). Since the number of examined lymph nodes differed by region, separate analyses divided by number of examined lymph nodes were also carried out for patients with mastectomy (Figure 5) and those with breast-conserving surgery (Figure 6). There were no significant survival differences between the regions (Figures 5 and 6).
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Figure 3.
Relative survival of all patients with one to three positive nodes from the west (n = 2750) and southeast (n = 1698) regions.
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Figure 4.
Relative survival of patients with one to three positive nodes divided by type of surgery. Mastectomy: west (n = 1490) and southeast (n = 1012) regions. Breast-conserving surgery: west (n = 1260) and southeast (n = 686) regions.
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Figure 5.
Relative survival of patients with one to three positive nodes who underwent mastectomy. Patients separated according to the number of lymph nodes analyzed: 1–5 nodes analyzed, west (n = 99) and southeast (n = 136) regions; 6–10 nodes analyzed, west (n = 429) and southeast (n = 432) regions; 11–15 nodes analyzed, west (n = 445) and southeast (n = 302) regions; and >15 nodes analyzed, west (n = 510) and southeast (n = 139) regions.
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Figure 6.
Relative survival of patients with one to three positive nodes who underwent breast-conserving surgery. Patients separated according to the number of lymph nodes analyzed: 1–5 nodes analyzed, west (n = 121) and southeast (n = 95) regions; 6–10 nodes analyzed, west (n = 333) and southeast (n = 297) regions; 11–15 nodes analyzed, west (n = 367) and southeast (n = 205) regions; and >15 nodes analyzed, west (n = 433) and southeast (n = 87) regions.
The guidelines were identical between the two regions with respect to radiotherapy for patients without lymph node involvement, as well as for those with >3 positive nodes. A relative survival comparison of these two groups yielded almost identical relative survival outcomes between the two regions (data not shown).
Results
In the W region, 15% (225/1490) of the patients with one to three positive nodes had postmastectomy radiotherapy and 87% (1099/1260) of the patients who underwent breast-conserving surgery and had one to three positive nodes received breast radiotherapy. The corresponding figures for patients with one to three positive nodes in the SE region were 89% (905/1012) for postmastectomy radiotherapy and 96% (657/686) for breast and regional radiotherapy after breast-conserving surgery. The median number of examined lymph nodes among patients with one to three positive nodes was 13 in the W region and ten in the SE region. The distribution of lymph nodes examined is shown in Figure 2. The use of adjuvant endocrine therapy was similar between the regions: W region, 54% (1482/2750) and SE region, 60% (1021/1698). Adjuvant chemotherapy was slightly more common in the W region, 42% (1167/2750) compared with 25% (421/1698) in the SE region.
(Enlarge Image)
Figure 2.
Distribution of number of axillary lymph nodes analyzed in patients with one to three positive nodes in the west (n = 2750) and southeast (n = 1698) regions.
The relative survival of patients with one to three positive lymph nodes in the two regions was similar (Figure 3). The 10-year relative survival was 78% in the W region and 77% in the SE region (P = 0.12), Separating the relative survival analyses for patients with mastectomy and those with breast-conserving surgery resulted in similar results for the two regions (Figure 4). Since the number of examined lymph nodes differed by region, separate analyses divided by number of examined lymph nodes were also carried out for patients with mastectomy (Figure 5) and those with breast-conserving surgery (Figure 6). There were no significant survival differences between the regions (Figures 5 and 6).
(Enlarge Image)
Figure 3.
Relative survival of all patients with one to three positive nodes from the west (n = 2750) and southeast (n = 1698) regions.
(Enlarge Image)
Figure 4.
Relative survival of patients with one to three positive nodes divided by type of surgery. Mastectomy: west (n = 1490) and southeast (n = 1012) regions. Breast-conserving surgery: west (n = 1260) and southeast (n = 686) regions.
(Enlarge Image)
Figure 5.
Relative survival of patients with one to three positive nodes who underwent mastectomy. Patients separated according to the number of lymph nodes analyzed: 1–5 nodes analyzed, west (n = 99) and southeast (n = 136) regions; 6–10 nodes analyzed, west (n = 429) and southeast (n = 432) regions; 11–15 nodes analyzed, west (n = 445) and southeast (n = 302) regions; and >15 nodes analyzed, west (n = 510) and southeast (n = 139) regions.
(Enlarge Image)
Figure 6.
Relative survival of patients with one to three positive nodes who underwent breast-conserving surgery. Patients separated according to the number of lymph nodes analyzed: 1–5 nodes analyzed, west (n = 121) and southeast (n = 95) regions; 6–10 nodes analyzed, west (n = 333) and southeast (n = 297) regions; 11–15 nodes analyzed, west (n = 367) and southeast (n = 205) regions; and >15 nodes analyzed, west (n = 433) and southeast (n = 87) regions.
The guidelines were identical between the two regions with respect to radiotherapy for patients without lymph node involvement, as well as for those with >3 positive nodes. A relative survival comparison of these two groups yielded almost identical relative survival outcomes between the two regions (data not shown).
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