Notably, the EBCTCG meta-analysis reported that LRR and AFR occurred more frequently in the no-RT group treated with axillary sampling than in the no-RT group treated with axillary dissection; however, the difference disappeared when PMRT was added, irrespective of axillary management. In contrast, we found no difference in the LRR or AFR rate according to axillary management. Moreover, the 10-year LRR and AFR rates were far superior to the outcomes of the EBCTCG in node-negative patients (the 10-year AFR and LRR rates were 7.9% and 3.8%, respectively). Even for the high-risk group defined in our study, the 10-year AFR and LRR rates were 18.1% and 12.4%, respectively. Considering the period of patient enrollment (1964-1986 in the EBCTCG meta-analysis vs. 2005-2011 in our study), it is reasonable that this reduction in recurrence is attributable to improved nodal examination, such as sentinel LN detection or pathologic evaluation, and progress in systemic treatments such as HER2 targeted therapy. Importantly, routine use of systemic treatment, which was given to 90% of our study cohort, could also explain these superior outcomes, in that recent large clinical trials emphasized the impact of systemic treatment in terms of not only DM and survival, but also local control [18–20].