Effect of axillary nodal status on the long-term survival following mastectomy for breast carcinoma: nodal metastases may not always suggest systemic disease.

Records of 215 patients receiving radical mastectomies from 1958 to 1968 at Roswell Park Memorial Institute were reviewed for the significance of axillary nodal status on long-term survival and recurrence. Ten-year disease-free interval rates were 83%, 47%, and 17%, respectively, for patients with negative nodes, 1-3 positive nodes, and greater than or equal to 4 positive nodes. Fifteen-year rates were 80%, 37%, and 8%, respectively. Survival and disease-free interval curves for the 3 nodal status groups were significantly different from each other (P less than 0.0001). Curves for three subclasses of the greater than or equal to 4 positive node group (4-6, 7-12, and greater than or equal to 13) were similar in overall survival, but were significantly (P = 0.04) different for disease-free interval, due to a rapid rate of recurrence in the greater than or equal to 13 positive node group. Hazard rates of treatment failure during each successive 3-year period for 9 years following mastectomy for those with 1-3 positive nodes or greater than or equal to 4 positive nodes decreased with time, whereas the rates for those with negative nodes were low and relatively constant throughout follow-up. These findings support the thesis that a significant proportion of negative nodes patients are cured by mastectomy and that a smaller group of node-positive patients have regional disease with a chance of cure by mastectomy.