Treatment results of 4480 patients with primary resectable breast cancer after surgery at Kodama Breast Clinic in the past 26 years

In the past 26 years, 4480 patients with primary breast cancer underwent surgery at our clinic, and the treatment results were analyzed using the survival rate and multivariate analysis. The patients were all female and the mean age was 52.7 (24-89). The type of surgery, histology and stage were as follows: 2533 (56.3%) mastectomies and 1949 (43.5%) breast-conserving surgeries; 4257 invasive carcinomas, 174 non-invasive carcinomas, 5 Paget's diseases and 44 with unclear histology :174 stage 0, 1225 I, 1480 IIA, 670 IIB, 350 IIIA, 207 IIIB, 287 IIIC, 76 IV, and 11 unclassified. Overall 5- and 10-year survival rates were 90.9% and 84.8%, respectively. The pathological tumor-node-metastasis (pTNM) stage classification exactly reflected the survival after surgery, however the survival rate of Stage 3B was higher than that of Stage 3A. Hazard analysis demonstrated that the hazard ratio for recurrence decreased after surgery, but that for breast cancer-related death reached peak 2-4 years after surgery. Multivariate analysis demonstrated that breast-conservation was a significant variable to decrease the risk: the survival rate after breast-conserving surgery was significantly higher than that after mastectomy. The positive Estrogen Receptor (ER) expression was a significant variable to decrease the risk, but the level of axillary dissection and adjuvant therapy were not significant variables. Stage 3B classification is not appropriate. Breast-conserving surgery should be applied as widely as possible. The level of axillary dissection should be reduced. Adjuvant therapy with oral fluoropyrimidines and tamoxifen resulted in a satisfactory survival rate for Stage 1-3 B breast cancer, and an intensive adjuvant therapy should be applied for Stage 3C and 4 breast cancer. (author)