Prognostic factors for locoregional recurrence and survival in stage IIIC breast carcinoma: impact of adjuvant radiotherapy

Kuru B
Correspondence: Dr Bekir Kuru, bekirkuru@yahoo.com

ABSTRACT
Introduction The aims of the present study were to define the prognostic factors for locoregional recurrence (LRR) and survival in stage IIIC breast carcinoma as well as to examine the impact of adjuvant radiotherapy on the outcome of the disease.
Methods The records of 586 consecutive patients with stage IIIC breast carcinoma who underwent modified radical mastectomy were evaluated, and the prognostic factors for LRR and survival were analysed. Survival curves were generated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard model.
Results Five-year LRR and survival of stage IIIC breast carcinoma were 15 percent and 41.3 percent, respectively. Five-year LRR was significantly lower and five-year survival was significantly higher for all patients as well as for T1–2 patients with one to three apical node involvements who were treated with adjuvant radiotherapy. In multivariate analysis, apical node involvement, age below 35 years, T4 tumour, grade 3, extracapsular extension and lymphovascular invasion decreased survival, whereas adjuvant tamoxifen and adjuvant radiotherapy risk ratio [RR] 0.51, 95 percent confidence interval [CI] 0.39–0.67) increased survival. Adjuvant radiotherapy was the sole independent factor that was found to be significantly associated with decreased LRR (RR 0.25, 95 percent CI 0.16–0.38).
Conclusion Radiotherapy decreased LRR and increased survival significantly in all stage IIIC patients and in the subgroup of T1–2 patients with one to three apical node involvements. Thus, it should be considered in the treatment of stage IIIC breast carcinoma.

Keywords: adjuvant radiotherapy, apex axillary invasion, one to three positive axillary nodes, stage IIIC breast carcinoma
Singapore Med J 2011; 52(4): 289-298