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Background and Objectives Patients with node-negative breast cancer (NNBC) usually have a good prognosis, but tumor recurrence still compromises survival. In this study, we sought to identify clinical and pathologic factors that predict recurrence. Methods A total of 716 patients who were proved with pT1-2N0M0 breast cancer between 2005 and 2009 were enrolled in this study. Results Forty-seven of the 716 patients developed tumor recurrence during the 47.0 months of median follow-up. The significant risk factors of recurrence were lymphovascular invasion (LVI) (hazard ratio [HR] = 4.60, 95% CI. 2.32–9.10) and Nottingham grade 3 (HR = 4.99, 95% CI. 1.06–23.48); adjuvant radiotherapy (HR = 0.35, 95% CI. 0.14–0.92) prevented tumor recurrence. Furthermore, we investigate the therapeutic impact of adjuvant chemotherapy and radiotherapy on patients with LVI and Nottingham grade 3. The adverse effect of LVI and grade 3 can be abrogated by adjuvant radiotherapy in recurrence-free survival (RFS) (LVI(+)radiotherapy(+), no recurrence; grade 3(+)radiotherapy(+), HR = 0.82, 95% CI. 0.18–3.70). However, adjuvant chemotherapy did not. Conclusions LVI and Nottingham grade 3 were the independent risk factors predicting tumor recurrence for patients with NNBC. Adjuvant radiotherapy might be considered in NNBC patients with these unfavorable factors to improve the RFS. J. Surg. Oncol. 2013; 108:352–357. © 2013 Wiley Periodicals, Inc.

Neoadjuvant chemotherapy in breast cancer was developed in the 1970s and is now used in patients with locally advanced or early resectable breast cancer. Early administration of systemic chemotherapy before local treatment in locally advanced breast cancer and early resectable breast cancer is intended to downstage the primary tumor to make subsequent local treatment (surgery/or radiotherapy) easier and, it is hoped, to eliminate occult distant micrometastases to prolong survival. Despite the theoretical and experimental data indicating the survival superiority of neoadjuvant chemotherapy over postoperative adjuvant chemotherapy, the role of neoadjuvant chemotherapy in treatment of breast cancer remains unclear. But for the effect of down-staging the primary tumor is confirmed, 60-80% of patients with resectable breast cancer can be treated by a breast conservation procedure after neoadjuvant chemotherapy. Large randomized clinical trials are needed to evaluate the survival benefit for neoadjuvant chemotherapy. The detection of clinical and new biological markers will be studied to select the nonresponders of neoadjuvant chemotherapy for alternative treatment approaches.