Post-mastectomy Radiotherapy in T1-2 Breast Cancer Patients With One to Three Lymph Node Metastases: A Propensity Score Matching Analysis

被引：8

作者：

Chen, Maoshan ^{[1
]}

Huang, Yunhui ^{[1
]}

Leng, Zhengwei ^{[2
]}

Yang, Guanglun ^{[3
]}

Li, Fangfang ^{[4
]}

Yang, Hongwei ^{[1
]}

Hou, Lingmi ^{[2
]}

机构：

[1] Suining Cent Hosp, Dept Breast Surg, Suining, Peoples R China

[2] North Sichuan Med Coll, Affiliated Hosp, Dept Breast & Thyroid Surg, Hepatobiliary & Pancreat Inst, Nanchong, Peoples R China

[3] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrine & Breast Surg, Chongqing, Peoples R China

[4] Suining Cent Hosp, Dept Operating Room, Suining, Peoples R China

来源：

FRONTIERS IN ONCOLOGY | 2020年 / 9卷

关键词：

breast neoplasms; lymph node; radiotherapy; prognosis; Surveillance; Epidemiology; and End Results (SEER) Program; LOCOREGIONAL RADIATION-THERAPY; RECURRENCE RISK; POSITIVE NODES; MASTECTOMY; SURGERY; SURVIVAL; SOCIETY; AXILLA; TUMORS; WOMEN;

D O I：

10.3389/fonc.2019.01551

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background and Objectives: Whether post-mastectomy radiotherapy (PMRT) could improve prognosis for T1-2 breast cancer patients with one to three lymph node metastases remains controversial. The present study aimed to determine the significance of PMRT in patients with T1-2N1M0 breast cancer. Methods: Data of 45,646 patients from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed; 12,585 matched patients were divided into a PMRT group and non-radiotherapy group (no-PMRT), respectively, using the propensity score matching method. Univariate and multivariate analyses were performed to determine the prognostic factors of breast cancer, and subgroup analysis was performed according to the number of lymph node metastases. Results: With the median follow-up of 62 months, 5-year cancer-specific survival was 91.48% in the PMRT group and 91.88% in the no-PMRT group (P = 0.405). PMRT did not improve the breast cancer-specific survival (BCSS) in patients with stage T1-2N1M0 (HR = 0.99, 95% CI = 0.92-1.06, P = 0.715). In subgroup analysis, radiotherapy improved the BCSS in patients with three nodes positive, with the 5-year BCSS at 88.5% in the radiation group and 86.6% in the no-radiation group (HR = 0.78, 95% CI = 0.65-0.90, P < 0.001). In patients with two nodes positive, 5-year BCSS was 90.3% in the PMRT group and 89.5% in the no-PMRT group, with no significant difference between the two groups (HR = 0.96, 95% CI = 0.85-1.09, P = 0.552). In patients with one node positive, 5-year BCSS was higher in the no-PMRT group (92.1%) than that in the PMRT group (90.8%); radiotherapy increased the cancer-related death compared with those who did not receive it (HR = 1.21, 95% CI = 1.08-1.36, P = 0.002). Conclusion: The benefit of PMRT in T1-2N1M0 patients was obviously different, and the recommendation of PMRT for this population should be individualized. PMRT should be considered for patients with three nodes positive, should be suggested cautiously in those with two nodes positive, and could be omitted in those with one node positive.

引用

页数：9

共 32 条

[1] Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J].

Cardoso, F. ;

Kyriakides, S. ;

Ohno, S. ;

Penault-Llorca, F. ;

Poortmans, P. ;

Rubio, I. T. ;

Zackrisson, S. ;

Senkus, E. .

ANNALS OF ONCOLOGY, 2019, 30 (08) :1194-1220

[2] De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017 [J].

Curigliano, G. ;

Burstein, H. J. ;

Winer, E. P. ;

Gnant, M. ;

Dubsky, P. ;

Loibl, S. ;

Colleoni, M. ;

Regan, M. M. ;

Piccart-Gebhart, M. ;

Senn, H. -J. ;

Thurlimann, B. ;

Andre, F. ;

Baselga, J. ;

Bergh, J. ;

Bonnefoi, H. ;

Brucker, S. Y. ;

Cardoso, F. ;

Carey, L. ;

Ciruelos, E. ;

Cuzick, J. ;

Denkert, C. ;

Di Leo, A. ;

Ejlertsen, B. ;

Francis, P. ;

Galimberti, V. ;

Garber, J. ;

Gulluoglu, B. ;

Goodwin, P. ;

Harbeck, N. ;

Hayes, D. F. ;

Huang, C. -S. ;

Huober, J. ;

Khaled, H. ;

Jassem, J. ;

Jiang, Z. ;

Karlsson, P. ;

Morrow, M. ;

Orecchia, R. ;

Osborne, K. C. ;

Pagani, O. ;

Partridge, A. H. ;

Pritchard, K. ;

Ro, J. ;

Rutgers, E. J. T. ;

Sedlmayer, F. ;

Semiglazov, V. ;

Shao, Z. ;

Smith, I. ;

Toi, M. ;

Tutt, A. .

ANNALS OF ONCOLOGY, 2017, 28 (08) :1700-1712

[3] Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial [J].

Donker, Mila ;

van Tienhoven, Geertjan ;

Straver, Marieke E. ;

Meijnen, Philip ;

van de Velde, Cornelis J. H. ;

Mansel, Robert E. ;

Cataliotti, Luigi ;

Westenberg, A. Helen ;

Klinkenbijl, Jean H. G. ;

Orzalesi, Lorenzo ;

Bouma, Willem H. ;

van der Mijle, Huub C. J. ;

Nieuwenhuijzen, Grard A. P. ;

Veltkamp, Sanne C. ;

Slaets, Leen ;

Duez, Nicole J. ;

de Graaf, Peter W. ;

van Dalen, Thijs ;

Marinelli, Andreas ;

Rijna, Herman ;

Snoj, Marko ;

Bundred, Nigel J. ;

Merkus, Jos W. S. ;

Belkacemi, Yazid ;

Petignat, Patrick ;

Schinagl, Dominic A. X. ;

Coens, Corneel ;

Messina, Carlo G. M. ;

Bogaerts, Jan ;

Rutgers, Emiel J. T. .

LANCET ONCOLOGY, 2014, 15 (12) :1303-1310

[4] Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials [J].

Darby S. ;

McGale P. ;

Correa C. ;

Taylor C. ;

Arriagada R. ;

Clarke M. ;

Cutter D. ;

Davies C. ;

Ewertz M. ;

Godwin J. ;

Gray R. ;

Pierce L. ;

Whelan T. ;

Wang Y. ;

Peto R. ;

Albain K. ;

Anderson S. ;

Barlow W. ;

Bergh J. ;

Bliss J. ;

Buyse M. ;

Cameron D. ;

Carrasco E. ;

Coates A. ;

Collins R. ;

Costantino J. ;

Cuzick J. ;

Davidson N. ;

Davies K. ;

Delmestri A. ;

Di Leo A. ;

Dowsett M. ;

Elphinstone P. ;

Evans V. ;

Gelber R. ;

Gettins L. ;

Geyer C. ;

Goldhirsch A. ;

Gregory C. ;

Hayes D. ;

Hill C. ;

Ingle J. ;

Jakesz R. ;

James S. ;

Kaufmann M. ;

Kerr A. ;

MacKinnon E. ;

McHugh T. ;

Norton L. ;

Ohashi Y. .

LANCET, 2011, 378 (9804) :1707-1716

[5] Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials [J].

Early Breast Cancer Trialists' Collaborative Group .

LANCET, 2000, 355 (9217) :1757-1770

[6] The Confluence of Stereotactic Ablative Radiotherapy and Tumor Immunology [J].

Finkelstein, Steven Eric ;

Timmerman, Robert ;

McBride, WilliamH. ;

Schaue, Doerthe ;

Hoffe, Sarah E. ;

Mantz, Constantine A. ;

Wilson, George D. .

CLINICAL & DEVELOPMENTAL IMMUNOLOGY, 2011,

[7] Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines [J].

Frasier, Lane L. ;

Holden, Sara ;

Holden, Timothy ;

Schumacher, Jessica R. ;

Leverson, Glen ;

Anderson, Bethany ;

Greenberg, Caprice C. ;

Neuman, Heather B. .

JAMA ONCOLOGY, 2016, 2 (01) :95-101

[8] Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis The ACOSOG Z0011 (Alliance) Randomized Clinical Trial [J].

Giuliano, Armando E. ;

Ballman, Karla V. ;

McCall, Linda ;

Beitsch, Peter D. ;

Brennan, Meghan B. ;

Kelemen, Pond R. ;

Ollila, David W. ;

Hansen, Nora M. ;

Whitworth, Pat W. ;

Blumencranz, Peter W. ;

Leitch, A. Marilyn ;

Saha, Sukamal ;

Hunt, Kelly K. ;

Morrow, Monica .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 318 (10) :918-926

[9] Treatment of Regional Lymph Nodes in Breast Cancer-Not Recommended for All Patients With 1 to 3 Positive Auxiliary Nodes [J].

Harris, Jay R. .

JAMA ONCOLOGY, 2016, 2 (08) :991-992

[10] Use of Postmastectomy Radiotherapy and Survival Rates for Breast Cancer Patients with T1-T2 and One to Three Positive Lymph Nodes [J].

Huo, Dezheng ;

Hou, Ningqi ;

Jaskowiak, Nora ;

Winchester, David J. ;

Winchester, David P. ;

Yao, Katharine .

ANNALS OF SURGICAL ONCOLOGY, 2015, 22 (13) :4295-4304

← 1 2 3 4 →