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Jin L, Zhao Q, Fu S, Zhang Y, Wu S, Li X, Cao F. Who can benefit from postmastectomy radiotherapy among HR+/HER2- T1-2 N1M0 breast cancer patients? An explainable machine learning mortality prediction based approach. Front Endocrinol (Lausanne) 2024; 15:1326009. [PMID: 38375194 PMCID: PMC10875455 DOI: 10.3389/fendo.2024.1326009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
Objective The necessity of postmastectomy radiotherapy(PMRT) for patients with HR+/HER2 T1-2 N1M0 breast cancer remains controversial. We want to use explainable machine learning to learn the feature importance of the patients and identify the subgroup of the patients who may benefit from the PMRT. Additionally, develop tools to provide guidance to the doctors. Methods In this study, we trained and validated 2 machine learning survival models: deep learning neural network and Cox proportional hazard model. The training dataset consisted of 35,347 patients with HR+/HER2- T1-2 N1M0 breast cancer who received mastectomies from the SEER database from 2013 to 2018. The performance of survival models were assessed using a concordance index (c-index).Then we did subgroup analysis to identify the subgroup who could benefit from PMRT. We also analyzed the global feature importance for the model and individual feature importance for individual survival prediction. Finally, we developed a Cloud-based recommendation system for PMRT to visualize the survival curve of each treatment plan and deployed it on the Internet. Results A total of 35,347 patients were included in this study. We identified that radiotherapy improved the OS in patients with tumor size >14mm and age older than 54: 5-year OS rates of 91.9 versus 87.2% (radio vs. nonradio, P <0.001) and cohort with tumor size >14mm and grade worse than well-differentiated, 5-year OS rates of 90.8 versus 82.3% (radio vs. nonradio, P <0.001).The deep learning network performed more stably and accurately in predicting patients survival than the random survival forest and Cox proportional hazard model on the internal test dataset (C-index=0.776 vs 0.641) and in the external validation(C-index=0.769 vs 0.650).Besides, the deep learning model identified several key factors that significantly influence patient survival, including tumor size, examined regional nodes, age at 45-49 years old and positive regional nodes (PRN). Conclusion Patients with tumor size >14mm and age older than 54 and cohort with tumor size >14mm and grade worse than well-differentiated could benefit from the PMRT. The deep learning network performed more stably and accurately in predicting patients survival than Cox proportional hazard model on the internal test. Besides, tumor size, examined regional nodes, age at 45-49 years old and PRN are the most significant factors to the overall survival (OS).
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Affiliation(s)
- Long Jin
- Department of Radiation Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Qifan Zhao
- Department of Computer Science, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shenbo Fu
- Department of Radiation Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, China
| | - Yuan Zhang
- Department of Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Shuhan Wu
- Department of Surgical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xiao Li
- Internal Medicine, St. Luke's Hospital, Chesterfield, MO, United States
| | - Fei Cao
- Department of Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
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Liu J, Huang S, Bi Z, Zhang X, He Z, Lan X, Tan Y, Lin X, Zhou W, Huang X. De-escalated radiotherapy for HER2-overexpressing breast cancer patients with 1-3 positive lymph nodes undergoing anti-HER2 targeted therapy. Front Oncol 2023; 13:1280900. [PMID: 38023183 PMCID: PMC10646411 DOI: 10.3389/fonc.2023.1280900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background In the era of anti-HER2 targeted therapy, the potential clinical feasibility of considering HER2-overexpressing breast cancer cases presenting with 1-3 positive axillary lymph nodes as low-risk, and thereby contemplating postoperative radiotherapy reduction, remains an important subject for in-depth examination. The aim of this retrospective study was to evaluate the effectiveness of de-escalated radiotherapy in T1-2N1M0 HER2-overexpressing breast cancer patients receiving anti-HER2 targeted therapy. Specifically, omitting regional lymph node irradiation (RNI) after breast-conserving surgery and only performing whole-breast irradiation or omitting postmastectomy radiation therapy. Methods A retrospective analysis was conducted on 429 patients with stage T1-2N1M0 primary invasive HER2-overexpressing breast cancer from our center between 2004 and 2018. Patients who received anti-HER2 targeted therapy were divided into an RNI group and a no RNI group to assess the role of RNI. The prognostic role of RNI was investigated via the Kaplan-Meier method and Cox proportional hazards modeling. Results The median follow-up time was 46.8 months (range 7.1-225.8 months). In the anti-HER2 targeted therapy group RNI yielded no significant improvements in invasive disease-free survival (IDFS) (p = 0.940), local-regional recurrence-free survival (p = 0.380), distant metastases-free survival (p = 0.698), or overall survival (p = 0.403). Estrogen receptor (ER) status (hazard ratio [HR] 0.105, 95% confidence interval [CI] 0.023-0.749, p = 0.004) and lymph vascular invasion status (LVI) (HR 5.721, 95% CI 1.586-20.633, p = 0.008) were identified as independent prognostic factors for IDFS, and ER-positive and LVI-negative patients exhibited better prognoses. Conclusion Omitting RNI may be a safe option in T1-2N1 HER2-overexpressing breast cancer patients receiving standardized anti-HER2 targeted therapy; particularly in ER-positive or LVI-negative subgroups.
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Affiliation(s)
- Jing Liu
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Suning Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zhuofei Bi
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoxue Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ziqing He
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaowen Lan
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuting Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenyi Zhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaobo Huang
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Yat-Sen Breast Tumor Hospital, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Luo M, Jin Y, Xu C, Chen H, Zhang K, Chen Q, Jin C, Lu J, Wang J, Huang J, Deng H, Jin W, Zheng S, Chen Y, Zhou J. Postmastectomy radiotherapy in patients with T 1-2N 1 breast cancer: a single center experience and a meta-analysis. J Cancer Res Clin Oncol 2023; 149:9979-9990. [PMID: 37256383 DOI: 10.1007/s00432-023-04908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/20/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Postmastectomy radiotherapy (PMRT) in patients with T1-2N1 breast cancer is still controversial. This study was to evaluate the survival prognosis of T1-2N1 patients with or without PMRT. PATIENTS AND METHODS From January 2006 to May 2017, 2606 female breast cancer patients underwent mastectomy in our medical center, among whom 402 patients of T1-2N1 stage with or without PMRT were finally analyzed. The median follow-up duration was 59.5 months. The primary endpoint was overall survival (OS). The secondary endpoint was disease-free survival (DFS). RESULTS In the study of our center, no statistically significant difference was observed between the T1-2N1 PMRT and non-PMRT subgroups for the 5-year OS (94.4% vs 95.4%, p = 0.667) and DFS (90.1% vs. 91.1%, p = 0.798). By the date of the last follow-up, 8.96% (n = 36) of the patients experienced any recurrence. Univariate analysis revealed that PMRT was not a prognostic factor for either OS (p = 0.667) or DFS (p = 0.798) in T1-2N1 patients. We then did a meta-analysis on the current treatment patterns, in which 2606 PMRT and 4281 non-PMRT T1-2N1 breast cancer patients with mastectomy were included. The meta-analysis showed that PMRT didn't improve the OS of the patients (HR = 0.85, p = 0.11), but patients with PMRT had better DFS than those in the non-PMRT group (HR = 0.62, p < 0.001). CONCLUSION PMRT did not affect the survival of T1-2N1 breast cancer patients who underwent mastectomy, suggesting that radiotherapy may be safely omitted for them.
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Affiliation(s)
- Meng Luo
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Jin
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunjing Xu
- Department of Breast Surgery, Zhejiang Hospital, Hangzhou, China
| | - Huihui Chen
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Zhang
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Chen
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chencan Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinglu Lu
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wang
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Huang
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Deng
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weili Jin
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shu Zheng
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiding Chen
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China.
- Cancer Center, Zhejiang University, Hangzhou, China.
| | - Jiaojiao Zhou
- Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China.
- Cancer Center, Zhejiang University, Hangzhou, China.
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Pu H, Luo Y, Zhang L, Li X, Li F, Chen J, Qian S, Tang Y, Zhao X, Hou L, Gao Y. Development and validation of nomograms for predicting survival outcomes in patients with T1-2N1 breast cancer to identify those who could not benefit from postmastectomy radiotherapy. Front Oncol 2023; 13:1112687. [PMID: 37056328 PMCID: PMC10086367 DOI: 10.3389/fonc.2023.1112687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
PurposeIn this study, we aimed to develop and validate nomograms for predicting the survival outcomes in patients with T1-2N1 breast cancer to identify the patients who could not benefit from postmastectomy radiotherapy (PMRT).MethodsData from 10191 patients with T1-2N1 breast cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Of them, 6542 patients who had not received PMRT formed the training set. Concurrently, we retrospectively enrolled 419 patients from the Affiliated Hospital of North Sichuan Medical College (NSMC), and 286 patients who did not undergo PMRT formed the external validation set. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses were used for selecting prognostic factors in the training set. Using the selected factors, two prognostic nomograms were constructed. The nomograms’ performance was assessed using the concordance index (C-index), calibration curves, decision curve analysis (DCA), and risk subgroup classification. The stabilized inverse probability of treatment weights (IPTWs) was used to balance the baseline characteristics of the different risk groups. Finally, the survival outcomes and effectiveness of PMRT after IPTW adjustment were evaluated using adjusted Kaplan–Meier curves and Cox regression models.ResultsThe 8-year overall survival (OS) and breast cancer-specific survival (BCSS) rates for the SEER cohort were 84.3% and 90.1%, with a median follow-up time of 76 months, while those for the NSMC cohort were 84.1% and 86.9%, with a median follow-up time of 73 months. Moreover, significant differences were observed in the survival curves for the different risk subgroups (P < 0.001) in both SEER and NSMC cohorts. The subgroup analysis after adjustment by IPTW revealed that PMRT was significantly associated with improved OS and BCSS in the intermediate- (hazard ratio [HR] = 0.72, 95% confidence interval [CI]: 0.59–0.88, P=0.001; HR = 0.77, 95% CI: 0.62–0.95, P = 0.015) and high- (HR=0.66, 95% CI: 0.52–0.83, P<0.001; HR=0.74, 95% CI: 0.56–0.99, P=0.039) risk groups. However, PMRT had no significant effects on patients in the low-risk groups.ConclusionAccording to the prognostic nomogram, we performed risk subgroup classification and found that patients in the low-risk group did not benefit from PMRT.
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Affiliation(s)
- Hongyu Pu
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunbo Luo
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Linxing Zhang
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xin Li
- Department of Hepatobiliary Surgery I, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fangwei Li
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingtai Chen
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Shuangqiang Qian
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunhui Tang
- Department of Breast and Thyroid Surgery, Guang’an People’s Hospital, Chongqing, China
| | - Xiaobo Zhao
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Xiaobo Zhao, ; Lingmi Hou, ; Yanchun Gao,
| | - Lingmi Hou
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Xiaobo Zhao, ; Lingmi Hou, ; Yanchun Gao,
| | - Yanchun Gao
- Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Xiaobo Zhao, ; Lingmi Hou, ; Yanchun Gao,
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The role of postoperative radiation therapy in stage I–III male breast cancer: A population-based study from the surveillance, epidemiology, and End Results database. Breast 2022; 65:41-48. [PMID: 35810531 PMCID: PMC9272391 DOI: 10.1016/j.breast.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to investigate the role of postoperative radiation therapy in a large population-based cohort of patients with stage I–III male breast cancer (MaBC). Methods Patients with stage I–III breast cancer treated with surgery were selected from the Surveillance, Epidemiology, and End Results cancer database from 2010 to 2015. Multivariate logistic regression identified the predictors of radiation therapy administration. Multivariate Cox regression model was used to evaluate the predictors of survival. Results We identified 1321 patients. Age, stage, positive regional nodes, surgical procedure, and HER2 status were strong predictors of radiation therapy administration. There was no difference between patients who received radiation therapy and those who did not (P = 0.46); however, after propensity score matching, it was associated with improved OS (P = 0.04). In the multivariate analysis of the unmatched cohort, the factors associated with better OS were administration of radiation therapy and chemotherapy. In the subset analysis of the unmatched cohort, postoperative radiation therapy was associated with improved OS in men undergoing breast-conserving surgery (BCS), with four or more node-positive or larger primary tumours (T3/T4). Furthermore, we found no benefit of radiation therapy, regardless of the type of axillary surgery in mastectomy (MS). In older MaBC patients with T1-2N1 who underwent MS, radiation therapy showed no significant effects, regardless of chemotherapy. Conclusion Postoperative radiation therapy could improve the survival of MaBC patients undergoing BCS, with four or more node-positive or larger primary tumours. Moreover, it should be carefully considered in patients undergoing MS and older T1-2N1 patients. Postoperative radiation therapy may improve survival of some male breast cancer patients. Patients undergoing breast-conserving surgery or with large tumours may benefit. Radiation therapy had no benefits in mastectomy regardless of axillary surgery type. Radiation therapy was not effective in older T1-2N1 patients with receiving mastectomy.
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Van der Vorst A, Kindts I, Laenen A, Neven P, Janssen H, Weltens C. Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer. Breast 2022; 64:29-34. [PMID: 35468477 PMCID: PMC9059150 DOI: 10.1016/j.breast.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/26/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background To date, it remains unclear which patients with breast cancer (BC) benefit from post-mastectomy radiotherapy (PMRT). Cheng et al. developed and validated a scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients in need for PMRT. These factors include age, estrogen receptor status, lymphovascular status and number of affected axillary lymph nodes. Purpose To validate the scoring system for LRR in BC developed by Cheng et al. by using an independent BC database. Methods and materials We retrospectively identified 1989 BC cases, treated with mastectomy (ME) with or without PMRT at the University Hospitals Leuven between 2000 and 2007. The primary endpoint was 5-year locoregional control rate with and without PMRT, according to the LRR score. Results Median follow-up time was 11.4 years. After excluding patients with missing variables 1103 patients were classified using the LRR scoring system: 688 (62.38%) patients were at low risk of recurrence (LRR score 0–1), 335 (30.37%) patients were at intermediate risk of recurrence (LRR score 2–3) and 80 (7.25%) patients were at high risk of recurrence (LRR score ≥4). 5-year locoregional control rates with and without PMRT were 99.20% versus 99.21% (p = 0.43) in the low-risk group; 98.24% versus 85.74% (p < 0.0001) in the intermediate-risk group and 96.87% versus 85.71% (p = 0.10) in the high-risk group respectively. Conclusion Our validation of the LRR scoring system suggests it can be used to point out patients that would benefit from PMRT. We recommend further validation of this scoring system by other independent institutions before application in clinical practice. Post-mastectomy radiotherapy. Scoring system by Cheng et al. Based on 4 factors. Age, estrogen receptor, lymphovascular status, affected axillary lymph nodes. Intermediate and high-risk patients could benefit from post-mastectomy radiotherapy.
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Affiliation(s)
- Aline Van der Vorst
- UZ Leuven, Department of Radiation Oncology, Herestraat 49, 3000, Leuven, Belgium.
| | - Isabelle Kindts
- AZ Groeninge, Department of Radiation Oncology, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - Annouschka Laenen
- UZ Leuven, Department of Biostatistics and Statistical Bioinformatics, Herestraat 49, 3000, Leuven, Belgium.
| | - Patrick Neven
- UZ Leuven, Department of Gynaecology, Herestraat 49, 3000, Leuven, Belgium.
| | - Hilde Janssen
- UZ Leuven, Department of Radiation Oncology, Herestraat 49, 3000, Leuven, Belgium.
| | - Caroline Weltens
- UZ Leuven, Department of Radiation Oncology, Herestraat 49, 3000, Leuven, Belgium.
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Yamada A, Hayashi N, Kumamaru H, Nagahashi M, Usune S, Asaga S, Iijima K, Kadoya T, Kojima Y, Kubo M, Miyashita M, Miyata H, Ogo E, Tamura K, Tanakura K, Tada K, Niikura N, Yoshida M, Ohno S, Ishikawa T, Narui K, Endo I, Imoto S, Jinno H. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases: A retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer 2022; 172:31-40. [PMID: 35752154 DOI: 10.1016/j.ejca.2022.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM Postmastectomy radiotherapy (PMRT) is the standard treatment for locally advanced breast cancer. However, the effectiveness of PMRT in patients with pT1-2 and N1 tumours remains controversial. Therefore, this study aimed to determine the prognostic impact of PMRT in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases. METHODS Using data from the Japanese National Clinical Database from 2004 to 2012, we evaluated the association of PMRT with locoregional recurrence (LRR), any recurrence, and mortality. We enrolled patients who had undergone mastectomy and axillary node dissection and were diagnosed with pT1-2 and N1. We compared clinicopathological factors and prognosis between patients who received (PMRT group) and those who did not receive (No-PMRT group) PMRT. RESULTS Among 8914 patients enrolled, 492 patients belonged to the PMRT group and 8422 to the No-PMRT group. The median observation time was 6.3 years. There was no significant difference in the incidences of LRR (4.0% versus 5.0%, P = 0.61), recurrence (13.8% versus 11.8%, P = 0.23) and breast cancer death (6.0% versus 4.3%, P = 0.08) at 5 years between the groups. Multivariable analysis revealed that LRR was significantly associated with tumour size, number of node metastases and triple-negative subtype but not with PMRT. CONCLUSIONS The LRR rate in the No-PMRT group was 5.0% at 5 years among patients with T1-2 and N1. PMRT did not significantly influence LRR in patients with T1-2 and N1. However, PMRT administration should be tailored considering the individual risks of tumour size, 3 node metastases and triple-negative subtype.
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Affiliation(s)
- Akimitsu Yamada
- Department of Breast Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004 Japan.
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashicho, Chuou-ward, Tokyo, 104-8560, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ward, Tokyo, 113-8655, Japan.
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan.
| | - Shiori Usune
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ward, Tokyo, 113-8655, Japan.
| | - Sota Asaga
- Department of Breast Surgery, Kyorin University Hospital, 6-20-2, Arakawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kotaro Iijima
- Department of Breast Oncology, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan.
| | - Yasuyuki Kojima
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8111, Japan.
| | - Makoto Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ward, Tokyo, 113-8655, Japan.
| | - Etsuko Ogo
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kenji Tamura
- Cancer Genome Center, Shimane University Faculty of Medicine, 89-1 Shioharucho, Izumo, Shimane, 693-8501, Japan.
| | - Kenta Tanakura
- Department of Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Keiichiro Tada
- Department of Breast and Endocrine Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, Japan.
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Ishikawa
- Department of Breast Disease, Tokyo Medical University Hospital, 6-1-1 Sinjuku, Shinjuku-ward, Tokyo, 160-8402, Japan.
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ward, Yokohama, Kanagawa, 232-0024, Japan.
| | - Itaru Endo
- Department of Breast Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004 Japan.
| | - Shigeru Imoto
- Department of Breast Surgery, Kyorin University Hospital, 6-20-2, Arakawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Hiromitsu Jinno
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ward, Tokyo, 173-8606, Japan.
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Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1-2N1 breast cancer: who can omit adjuvant radiotherapy? Breast Cancer Res Treat 2021; 190:277-286. [PMID: 34490502 PMCID: PMC8558198 DOI: 10.1007/s10549-021-06378-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Purpose Postmastectomy radiation therapy (PMRT) in T1–T2 tumors with 1–3 positive axillary lymph nodes (ALNs) is controversial. This study was to identify prognostic factors of locoregional control (LRC) following mastectomy with or without PMRT for patients with T1-2N1 breast cancer and to discuss the selection of patients who might omit PMRT. Materials and methods Between January 2006 and December 2012, the data of 1474 postmastectomy patients staged pT1-2N1 were analyzed. PMRT was applied in 663 patients. LRC and disease-free survival (DFS) were calculated using the Kaplan–Meier method. Cox regression model was applied in the univariate and multivariate analyses to recognize the recurrence risk factors. Results With the median follow-up duration of 93 months (range, 5–168 months), 78 patients (5.3%) failed to secure LRC and 220 patients (14.9%) experienced any recurrence. The 7.7-year LRC and DFS was 94.9% and 85.4% respectively in the entire cohort. PMRT significantly improved 7.7-year LRC from 93.4% to 96.6% (p = 0.005), but not the DFS (p = 0.335). Multivariate analysis revealed that PMRT was an independent prognostic factor of LRC (p < 0.001), meanwhile, age ≤ 40 years (p = 0.012), histological grade 3 (p = 0.004), 2–3 positive nodes (p < 0.001) and tumor size of 3–5 cm (p = 0.045) were significantly associated with decreased LRC. The 7.7-year LRC for patients with 0, 1, and 2–4 risk factors was 97.7% / 98.9% (p = 0.233), 95.3% / 98.0% (p = 0.092), and 80.3% / 94.8% (p < 0.001) in the non-PMRT and PMRT group, respectively. Conclusions In patients with T1-2N1 breast cancer, clinical-pathological factors including young age, histological grade 3, 2–3 positive nodes, and tumor size of 3–5 cm were identified to be predictors of a poorer LRC following mastectomy. Patients with 0–1 risk factor might consider the omission of PMRT.
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Mastectomy alone for pT1-2 pN0-1 breast cancer patients: when postmastectomy radiotherapy is indicated. Breast Cancer Res Treat 2021; 188:511-524. [PMID: 33905020 DOI: 10.1007/s10549-021-06227-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess outcome of breast cancer (BC) stages pT1-2 N0-1 after mastectomy alone and to identify prognostic factors calling for the need of postmastectomy radiotherapy. METHODS Patients who were not eligible for breast conserving surgery (BCS) were operated on with mastectomy between 1998 and 2008. Locoregional (LRR), distant (DM) control and breast cancer specific survival (BCSS) were retrospectively evaluated. Cumulative incidence (CI) of events was estimated according to Kalbfleisch and Prentice while Gray's test tested difference. Kaplan-Meier method for survival and Cox proportional hazards model for univariable and multivariable analysis were used. A matched pair analysis between mastectomy alone and BCS plus whole breast irradiation (WBI), using the propensity score method, was performed. RESULTS 1281 pT1-2 N0 and 1081 pT1-2 N1 were identified. Median follow-up was 8.2 years (9.2 years for survival). Overall, LRR rate was low for both N0 and N1 subgroups (10-year CI, 8.8% and 10.9%, respectively). Young age, lymphovascular invasion and Ki-67 ≥ 20% were proved to be statistically significant prognostic factors at multivariable analysis. The combination of ≥ 2 risk factors increased LRR rate to ≥ 15%. Risk factors combination weighed on LRR rate more than nodal status itself. DM rate doubled moving from negative to positive nodal status (10-year CI 10.5% versus 20.3%, respectively). BCSS remained high in both N0 and N1 subgroups (10-year CI 92.4% versus 84.5%, respectively). Remarkably, all the molecular subtypes except Luminal A significantly affected DM and BCSS both in the N0 and N1 subgroups. Nodes number significantly impacted on DM and BCSS but not on locoregional control. In the matched pair analysis, WBI decreased nodal recurrence rate and improved distant control, without affecting survival. CONCLUSIONS Selected patients, namely those with at least two additional risk factors, presented high enough LRR risk to support the use of postmastectomy radiotherapy in both N0 and N1 subgroups. Moreover, the observation that radiotherapy may provide benefits that go beyond local control deserves to be further investigated.
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10
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Zhao JM, An Q, Sun CN, Li YB, Qin ZL, Guo H, Zeng X, Zhang YT, Wei LL, Han N, Sun SC, Zhang N. Prognostic factors for breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes and the role of postmastectomy radiotherapy in these patients. Breast Cancer 2020; 28:298-306. [PMID: 32940902 DOI: 10.1007/s12282-020-01158-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to identify independent prognostic factors for breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes, and discuss the role of postmastectomy radiotherapy(PMRT) in these patients. METHODS Between January 2005 and December 2015, the data on 840 eligible patients with breast cancer were retrospectively reviewed. Of these patients, 368 women received PMRT and 472 did not. The endpoints were locoregional recurrence (LRR) and distant metastasis (DM). RESULTS With a median follow-up of 62.0 months, multivariate analysis identified the following independent risk factors for increased LRR: tumor size ≥ 4 cm (HR: 2.994, 95% CI: 1.190-7.535, P = 0.020), ER- and PR-negative tumor (HR: 2.540, 95% CI: 1.165-5.537, P = 0.019), preoperative high neutrophil-to-lymphocyte ratio (NLR) (HR: 4.716, 95% CI: 1.776-12.528, P = 0.002)and low neutrophil-to-monocyte ratio (NMR) (HR: 0.231, 95% CI: 0.084-0.633, P = 0.004). And independent risk factors for increased DM: ER- and PR-negative tumor (HR: 2.540, 95% CI: 1.880-5.625, P = 0.000), high NLR (HR: 2.693, 95% CI: 1.426-5.084, P = 0.002) and low NMR (HR: 0.460, 95% CI: 0.257-0.824, P = 0.009). The high-risk patients (≥ 2 risk factors) had worse LRRFS and DFS than low-risk patients (0-1 risk factor) (all, P < 0.05). In the subgroup analysis, both low- and high-risk patients received PMRT had better LRRFS and DFS than those who without PMRT (all, P < 0.05), and the high-risk patients received PMRT had similar 5-year rates of LRRFS and DFS than low-risk patients who without PMRT (94.5 vs. 94.3%, P = 0.402; 83.4 vs.87.4%, P = 0.877, respectively). CONCLUSIONS Tumor size, ER/PR status, preoperative NLR and NMR were independent predictors of risk of recurrence. PMRT could improve locoregional control even in low-risk subgroup of breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes significantly.
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Affiliation(s)
- Jia-Ming Zhao
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Qi An
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Chao-Nan Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Yu-Bing Li
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Zi-Lan Qin
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Hong Guo
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Xue Zeng
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Yao-Tian Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Lin-Lin Wei
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Ning Han
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Shi-Chen Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Na Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China.
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Wei J, Jiang Y, Shao Z. The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype. Breast 2020; 51:40-49. [PMID: 32200207 PMCID: PMC7375676 DOI: 10.1016/j.breast.2020.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the significance of postmastectomy radiotherapy (PMRT) in female breast cancer patients with T1-2N1M0 disease according to molecular subtypes and other risk factors. METHOD We conducted a retrospective cohort-based study utilizing the Surveillance, Epidemiology, and End Results database. Patients who were diagnosed with T1-2N1M0 invasive breast cancer and received mastectomy between 2010 and 2014 were enrolled in our study. Overall survival (OS) was calculated with Kaplan-Meier method, and multivariant Cox hazard model was conducted to identify the impact of PMRT according to molecular subtypes and other risk factors. Propensity score matching (PSM) was applied to balance measurable confounders. RESULTS Of all the 16,521 enrolled patients, 5775 (35.0%) cases received PMRT. The distribution of molecular subtype is 71.4% for Luminal A, 13.2% for Luminal B, 5.1% for HER2 enriched, and 10.3% for TNBC. The OS was significantly better for patients in PMRT group than the Non-PMRT group (P < 0.0001). Stratified by molecular subtype, PMRT significantly prolonged survival in Luminal A patients (HR: 0.759, 95% CI: 0.651-0.884, P < 0.001), Yet it brought no significant survival advantage in Luminal B, TNBC or HER2 enriched subtype (P = 0.914, P = 0.124, P = 0.103, respectively). Also, PMRT bore prognostic significance among those patients who were older than 56 years old, single, white, exempt from reconstruction and chemotherapy, and were with ductal, GradeⅡtumor (all P < 0.05). After PSM, the survival benefit of PRMT sustained in Luminal A patients with T1 tumor concomitant with one positive lymph node. CONCLUSION Our study demonstrates a beneficial impact for PMRT on overall survival among Luminal A subtype breast cancer patients with T1-2N1 disease. The selection of PMRT should be stratified by molecular subtype and other risk factors.
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Affiliation(s)
- Jinli Wei
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Cancer Institute, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Yizhou Jiang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Cancer Institute, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Cancer Institute, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, PR China.
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12
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Li FY, Lian CL, Lei J, Wang J, Hua L, He ZY, Wu SG. Real-world impact of postmastectomy radiotherapy in T1-2 breast cancer with one to three positive lymph nodes. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:489. [PMID: 32395533 PMCID: PMC7210210 DOI: 10.21037/atm.2020.03.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The utility of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-2 (tumor size ≤5 cm) and N1 (one to three lymph nodes involved) disease remains controversial. The aim of this population-based study was to investigate the effectiveness of PMRT in this patient subset in the current clinical practice. Methods We included T1-2N1 breast cancer patients treated with mastectomy from 2004 to 2012 using the data form the Surveillance, Epidemiology, and End Results program. The association of PMRT administration with breast cancer-specific survival was determined using multivariable Cox analysis. Results We identified 10,248 patients of this study, including 3,725 (36.3%) received PMRT and 6,523 (63.7%) patients did not receive PMRT. Use of PMRT showed increase from 2008 onward; the percentage of patients receiving PMRT was 30.6% in 2004 and was 47.1% in 2012 (P<0.001). Patients diagnosis after 2008, aged <50 years, high tumor grade, T2 stage, and ≥2 positive lymph nodes were independently related to PMRT receipt. Multivariate analysis indicated that PMRT was not related to better breast cancer-specific survival compared to those without PMRT both before (P=0.186) and after propensity score matching (P=0.137). Conclusions In breast cancer with T1-2N1 disease, PMRT does not appear to improve survival in the era of modern systemic therapy.
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Affiliation(s)
- Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Jian Lei
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Jun Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Li Hua
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - San-Gang Wu
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
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13
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Krug D, Baumann R, Budach W, Duma MN, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Piroth MD, Sedlmayer F, Souchon R, Wenz F, Sauer R. Commercially Available Gene Expression Assays as Predictive Tools for Adjuvant Radiotherapy? A Critical Review. Breast Care (Basel) 2020; 15:118-126. [PMID: 32398980 DOI: 10.1159/000505656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022] Open
Abstract
Background Gene expression assays are increasingly used for decision-making regarding adjuvant chemotherapy in patients with hormone receptor-positive, HER2-negative breast cancer. There are some clinical situations in which there is also a need for better prognostic and predictive markers to better estimate the amount of benefit from adjuvant radiotherapy. The rising availability of gene expression analyses prompts the question whether their results can also be used to guide clinical decisions regarding adjuvant radiation. Summary Multiple studies suggest a correlation between results from gene expression assays and locoregional recurrence rates. Only few publications addressed the predictive value of results from gene expression analysis for the role of adjuvant radiotherapy in different settings. Key Messages To date, the available evidence on the possible predictive value of gene expression assays for radiotherapy does not support their inclusion into the decision-making process for adjuvant radiation. This is due to methodological weaknesses and limitations regarding patient selection, the nonrandomized design of all studies in terms of radiotherapy use, and limited availability of tissue from prospective trials. Thus, utilization of the present knowledge for clinical indication of radiotherapy should be very cautious.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - René Baumann
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Wulf Haase
- St.-Vincentius-Hospital, Karlsruhe, Germany
| | | | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Marc D Piroth
- HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | | | | | - Rolf Sauer
- University Hospital Erlangen, Erlangen, Germany
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14
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Kayali M, Abi Jaoude J, Tfayli A, El Saghir N, Poortmans P, Zeidan YH. Post-mastectomy radiation therapy in breast cancer patients with 1-3 positive lymph nodes: No one size fits all. Crit Rev Oncol Hematol 2020; 147:102880. [PMID: 32045847 DOI: 10.1016/j.critrevonc.2020.102880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/05/2019] [Accepted: 01/17/2020] [Indexed: 01/04/2023] Open
Abstract
Post-mastectomy radiation therapy (PMRT) is standard therapy for advanced breast cancer. However, given the lower risk of recurrence, PMRT administration remains controversial in select patients with limited nodal disease. We performed a review of the literature that focuses on the effect of PMRT in breast cancer patients with 1-3 positive lymph nodes, mainly examining loco-regional recurrence (LRR) and overall survival (OS). Most studies, including a large meta-analysis by the EBCTCG, showed a significant improvement in LRR rates among patients receiving PMRT. While most studies demonstrated a trend towards OS improvement, only few studies showed a statistically significant OS or breast cancer-specific survival benefit for PMRT. As such, individualized treatment decisions are recommended, taking into consideration clinicopathological findings. Future studies with large sample sizes and long follow-up times are still needed to better assess the role of PMRT in patients with limited nodal involvement.
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Affiliation(s)
- Majd Kayali
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Arafat Tfayli
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi El Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Philip Poortmans
- Department of Radiation Oncology, Institut Curie & Paris Sciences & Lettres - PSL University, Paris, France
| | - Youssef H Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
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15
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Tadros AB, Moo TA, Stempel M, Zabor EC, Khan AJ, Morrow M. Axillary management for young women with breast cancer varies between patients electing breast-conservation therapy or mastectomy. Breast Cancer Res Treat 2020; 180:197-205. [PMID: 31938938 DOI: 10.1007/s10549-019-05520-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Axillary treatment strategies for the young woman with early-stage, clinically node-negative breast cancer undergoing upfront surgery found to have 1-3 positive sentinel lymph nodes (SLNs) differ significantly after BCT and mastectomy. Here we compare axillary lymph node dissection (ALND) and regional nodal irradiation (NRI) rates between women electing breast-conservation therapy (BCT) versus mastectomy. METHODS From 2010 to 2016, women age < 50 years with clinical T1-T2N0 breast cancer having upfront surgery and found to have a positive SLN were identified. ALND and/or NRI receipt were compared between groups. RESULTS 192 women undergoing BCT and 165 undergoing mastectomy were identified (median age: 44 years). 5.2% (10/192) of women undergoing BCT had an ALND versus 87% (144/165) of women undergoing mastectomy (p < 0.01). NRI was given to 48% (78/165) of mastectomy patients compared to 30% (57/192) of BCT patients (p < 0.01). Of the 75 mastectomy patients with 1-2 total positive lymph nodes after completion ALND, 44% received NRI. Women undergoing mastectomy were significantly more likely to receive both ALND and NRI than women undergoing BCS (45% vs 6%, p < 0.01). CONCLUSION Young cT1-2N0 breast cancer patients found to have 1-3 SLN metastases received ALND, NRI, and combined ALND/NRI more frequently if they elected mastectomy over BCT. Use of both ALND and postmastectomy radiotherapy (PMRT) in this population could be reduced in the future by omitting ALND in patients for whom the need for PMRT is clear with the finding of 1-2 SLN metastases.
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Affiliation(s)
- Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
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16
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Qi WX, Cao L, Xu C, Zhao S, Chen J. Adjuvant regional nodal irradiation did not improve outcomes in T1-2N1 breast cancer after breast-conserving surgery: A propensity score matching analysis of BIG02/98 and BCIRG005 trials. Breast 2019; 49:165-170. [PMID: 31812892 PMCID: PMC7375686 DOI: 10.1016/j.breast.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022] Open
Abstract
Aim To determine whether the addition of regional nodal irradiation (RNI) to whole-breast irradiation (WBI) would improve outcomes over WBI alone in T1-2N1 breast cancer after breast-conserving surgery (BCS) and adjuvant systematic therapy. Methods Data were obtained from two randomized controlled trials (NCT00174655 and NCT00312208). Univariate and multivariate Cox-regression analysis were performed to investigate predictors for overall survival and disease-free survival. A 1:1 propensity score matching (PSM) analysis was applied to eliminate selection bias. Results With median follow-up 80 months (range: 3–155 months), the 5-year local regional recurrence in the WBI group was 2% vs. 5% (p = 0.28) in the WBI + supraclavicular radiotherapy, and the rate of 5-year distant metastasis in the WBI group was 7% vs. 13% in the WBI + supraclavicular radiotherapy (p = 0.0748); In addition, the 5-year local regional recurrence in the WBI group was 3% vs. 9% (p = 0.19) in the WBI + internal mammary irradiation (IMI); However, the rate of 5-year distant metastasis in the in the WBI group was significantly lower than that in the WBI + IMI (8% vs. 24%, p = 0.036). After PSM, cox-regression analysis indicated that neither RNI nor IMI in combination with WBI in T1-2N1 breast cancer was associated with an improved overall survival and disease-free survival when compared to WBI alone. Conclusion The addition of RNI to WBI in T1-2N1 breast cancer after BCS and adjuvant systematic therapy did not improve outcomes in comparison with WBI alone. Further studies are still needed to identify patients who would most benefit from RNI in this patient population. The addition of RNI to WBI in unselected T1-2N1 breast cancer after BCS and adjuvant systematic therapy does not significantly improve outcomes in comparison with WBI alone. Early stage (pT1-2N1) breast cancer after BCS represents a diverse population. An individualized risk analysis based on clinical-genomic models is recommended to identify patients who would benefits or omit from RNI in further prospective studies.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shengguang Zhao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Abdel-Rahman O. Reply to the letter to the editor "Comment to 'Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1-2 N1 disease; an individual patient data analysis of three clinical trials'". Strahlenther Onkol 2019; 195:308-309. [PMID: 30758516 DOI: 10.1007/s00066-019-01433-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, T2N4N1, Calgary, Alberta, Canada.
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Comment to Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1-2 N1 disease; an individual patient data analysis of three clinical trials. Strahlenther Onkol 2019; 195:306-307. [DOI: 10.1007/s00066-018-1411-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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