Survival after mastectomy for breast cancer: Predictive value of lymphocyte count and its change after mastectomy in patients with metastases to one to three axillary nodes

A low preoperative lymphocyte count that increased after mastectomy was found to be a probably effective predictor of disease‐free survival in women with breast cancer and histologically proven metastases to 1–3 axillary nodes only. Two of 44 patients with < 2,000 lymphocytes/mm 3 , and 16 of 30 with > 2,000 lymphocytes/mm 3 preoperatively developed recurrence within 5 years after mastectomy (p<0.001). Eight patients died and all had preoperative lymphocyte counts of > 2,000/mm 3 (p<0.0001). None of 17 patients whose lymphocyte count remained unchanged or rose 1 week postoperatively developed recurrence, while 6 of 14 whose count fell did so (p<0.01). Postmastectomy irradiation was followed by a significant increase in metastases when the preoperative count was <2,000 lymphocytes/mm 3 (9 of 28 patients), compared to when the count was > 2,000/mm 3 (2 of 44 patients) (p<0.01). Patients with histologically proven metastases to 1–3 axillary nodes whose preoperative total lymphocyte count is < 2,000/mm 3 require no adjuvant therapy and seem to be made worse by radiation therapy. Those with > 2,000 lymphocytes/mm 3 will probably benefit from adjuvant chemotherapy.