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Clinicopathological factors associated with a high risk (>20%) of locoregional recurrence without PMRT include four or more involved lymph nodes, ⩾20% involvement of the number of axillary lymph nodes, T4 tumours, and T3 tumours combined with axillary nodal involvement [25,26].
Increased tumour size was positively associated with more involved lymph node (P < 0.01).
The largest subgroup of patients (61%) had one involved lymph node, 26% had two to three involved lymph nodes, and 11% had four or more involved lymph nodes.
Increased tumour size was positively associated with more involved lymph node (P < 0.001), the presence of lymphovascular invasion (P < 0.001), and loco-regional treatment (P < 0.001).
Within the IDC-DCIS group, higher IDC to DCIS size ratio correlated with more involved lymph nodes (Pearson's correlation coefficient, 0.112; P=0.006).
In the present study there was an approximate 80% reduction in 30 year cancer-specific survival in those patients with 4 or more involved lymph nodes.
Similar(51)
However, PMR has been shown to reduce LR and improve survival for patients with four or more involved regional lymph nodes or tumours >5 cm [ 23].
For patients with invasive cancer, postmastectomy radiation therapy was indicated for those with four or more involved axillary lymph nodes, but indications for its use in patients with one to three nodes were considered more restricted and particularly applicable for young patients and those with other poor prognostic features.
Moreover, on multiple Cox regression models, two parameters of axillary involvement were indicative of outcome: the presence of more than three involved lymph nodes and extracapsular spread.
'Luminal B' tumors and 'Luminal A' tumors with a grade 2/3 and/or more than three involved lymph nodes were classified as intermediate/high risk.
Presence of more than 3 involved lymph nodes increased cancer-specific mortality (HR 1.88, 95% CI 1.34-2.63) adjustmentstment for age, socio-economic deprivation and adjuvant treatment.
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