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I am still reading the original article, but the authors are making a lot of ASSUMPTIONS based on few facts and seeing if their statistics match their hypothesis, even if flawed.
In their experience those patients who had mastectomies had a shorter disease-related survival, however there may be other factors which caused the patients/their doctors to choose mastectomy which influenced survival, it may be that the inflammatory cascade set off by the surgery and not the micrometastases were at fault, there may be some substance (VEGF-C which is related to lymphatic-neogenesis ) which caused the lymph node metastasis which interacts with the physical or humoral results of surgery (perhaps the cortisol which is released due to the stress of surgery) resulting in more motility, more interaction with the stroma in bone, lung, brain or liver, etc.
I posted this even though it was based on too many assumptions for me to consider it in anyway definitive, as it is one of EXCEEDINGLY FEW studies which reported results for her2+ breast cancer's behavior ONLY.ie other articles discuss all breast cancers behavior or the behavior of ER+ or ER- breast cancers. IT is only by getting articles written about the natural history of her2+ breast cancer and how it responds to different treatment, whether SURGERY, Radiation therapy or chemo/immunotherapy that we will see whether previous attempts to fit all square pegs in a round hole ie, treat her2+breast cancer like other breast cancers has been appropriate or not.
Log hazard ratios have to do with how much more likely an even is to occur than one would expect and in this case the rate of early death was certainly "significantly increased" (not considering my caveats listed above)
Hope this helped!
Again, I was hesitant to post, but felt there might be someone perusing the site while deciding whether to have a mastectomy. I wouldn't let this article only sway someone, but as it involved her2+s only, it is certainly worth the read
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