The indication for adjuvant radiation therapy for early-stage breast cancer with one to three positive axillary lymph nodes has not been clearly defined. In this study, we investigated the local/regional recurrence after radical surgery and the risk prognostic factors for survival in this group of patients to provide a reference for postoperative adjuvant radiation therapy. The data of 217 breast cancer cases who underwent standard or modified radical surgery from March 1998 to March 2002 at the Cancer Control Center of Sun Yat-sen University were retrospectively analyzed. 71 cases with primary tumor pathological stage pT1 and 146 cases with pT2, of which 202 cases received adjuvant chemotherapy, 51 cases received adjuvant radiotherapy, and 116 cases received postoperative endocrine therapy. The median follow-up time was 69 months, and the statistical 5-year local recurrence-free survival (LRFS), tumor-free survival (DFS) and overall survival (OS) rates for the whole group were 85.2%, 81.8% and 90.2%, respectively. 44 cases developed tumor recurrence, including 21 cases of local/regional recurrence. Survival analysis showed that patients with local/regional recurrence had significantly lower 5-year overall survival than those with local/regional control (61.9% vs 93.6%, p<0.0001), and patient age ≤35 years, primary tumor pT2 and proportion of axillary lymph node metastasis ≥30% were poor prognostic factors affecting survival without local recurrence, disease-free survival and overall survival, and according to these 3 prognostic impact A scoring system was established based on these 3 prognostic influencing factors, and a statistically significant difference in 5-year local/regional recurrence-free survival was found for cases with different scores (p=0.0072). Among the 159 patients with ≥5 courses of adjuvant chemotherapy, 35 patients who received adjuvant radiotherapy had better survival indicators than those without radiation therapy. For patients with early stage breast cancer with one to three positive axillary lymph nodes, age ≤35 years, pT2 primary tumor and axillary lymph node metastasis ratio ≥30% suggest a higher risk of local/regional recurrence after surgery and adjuvant radiotherapy should be considered.