Effect of Postoperative Radiotherapy after Primary Tumor Resection in De Novo Stage IV Breast Cancer: A Multicenter Retrospective Study (KROG 19-02)
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Purpose: This study aimed to investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT. Materials and methods: This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively. Results: The median follow-up time was 53.7 months (range, 3.1 to 194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 category, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio, 0.64; 95% confidence interval, 0.50 to 0.82; p < 0.001), in addition to T1/2 category, ≤ 5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups (group 1, T1/2 and non-TNBC [n=193]; group 2, T3/4 and non-TNBC [n=171]; and group 3, TNBC [n=49]), and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regarding PFS in groups 1 and 2, not in group 3. Conclusion: PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 category and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.
Abstract
Purpose: This study aimed to investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT. Materials and methods: This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively. Results: The median follow-up time was 53.7 months (range, 3.1 to 194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 category, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio, 0.64; 95% confidence interval, 0.50 to 0.82; p < 0.001), in addition to T1/2 category, ≤ 5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups (group 1, T1/2 and non-TNBC [n=193]; group 2, T3/4 and non-TNBC [n=171]; and group 3, TNBC [n=49]), and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regarding PFS in groups 1 and 2, not in group 3. Conclusion: PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 category and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.
참고문헌 (25)
- DeSantis CE, "Breast cancer statistics, 2015 : convergence of incidence rates between black and white women", CA Cancer J Clin, 66, pp.31~42 (2016)
- Chia SK, "The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer", Cancer, 110, pp.973~979 (2007)
- Sundquist M, "Improved survival in metastatic breast cancer 1985-2016", Breast, 31, pp.46~50 (2017)
- Badwe R, "Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer : an open-label randomised controlled trial", Lancet Oncol, 16, pp.1380~1388 (2015)
- Soran A, "Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation : protocol MF07-01", Ann Surg Oncol, 25, pp.3141~3149 (2018)
- Fitzal F, "Impact of breast surgery in primary metastasized breast cancer : outcomes of the prospective randomized phase III ABCSG-28 POSYTIVE trial", Ann Surg, 269, pp.1163~1169 (2019)
- Khan SA, "randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: a trial of the ECOG-ACRIN Research Group (E2108)", J Clin Oncol, 38(18 Suppl), pp.LBA2~ (2020)
- Thomas A, "Initial surgery and survival in stage IV breast cancer in the United States, 1988-2011", JAMA Surg, 151, pp.424~431 (2016)
- Choi SH, "Locoregional treatment of the primary tumor in patients with de novo stage IV breast cancer : a radiation oncologist’s perspective", Clin Breast Cancer, 18, pp.e167~e178 (2018)
- Gnerlich J, "Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer : analysis of the 1988-2003 SEER data", Ann Surg Oncol, 14, pp.2187~2194 (2007)
- Gultekin M, "Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma", Breast, 23, pp.775~783 (2014)
- Kobayashi T, "Possible clinical cure of metastatic breast cancer : lessons from our 30-year experience with oligometastatic breast cancer patients and literature review", Breast Cancer, 19, pp.218~237 (2012)
- Eisenhauer EA, "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)", Eur J Cancer, 45, pp.228~247 (2009)
- Pons-Tostivint E, "Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis", Radiother Oncol, 145, pp.109~116 (2020)
- Golden EB, "Radiation fosters dose-dependent and chemotherapy-induced immunogenic cell death", Oncoimmunology, 3, pp.e28518~ (2014)
- Azami A, "Abscopal effect following radiation monotherapy in breast cancer : a case report", Mol Clin Oncol, 9, pp.283~286 (2018)
- Overgaard M, "Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial", N Engl J Med, 337, pp.949~955 (1997)
- Press MF, "HER-2", neu gene amplification characterized by fluorescence in situ hybridization : poor prognosis in node-negative breast carcinomas, 1997, pp.15, 2894~2904
- Swain SM, "Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer(CLEOPATRA study) : overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study", Lancet Oncol, 14, pp.461~471 (2013)
- Turner NC, "Overall survival with palbociclib and fulvestrant in advanced breast cancer", N Engl J Med, 379, pp.1926~1936 (2018)
- Brouckaert O, "Update on triple-negative breast cancer : prognosis and management strategies", Int J Womens Health, 4, pp.511~520 (2012)
- Pons-Tostivint E, "Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study : a propensity score-matched analysis", Ann Surg Oncol, 26, pp.356~365 (2019)
- Neuman HB, "Stage IV breast cancer in the era of targeted therapy : does surgery of the primary tumor matter?", Cancer, 116, pp.1226~1233 (2010)
- Pons-Tostivint E, "Is there a role for locoregional treatment of the primary tumor in de novo metastatic breast cancer in the era of tailored therapies? : Evidences, unresolved questions and a practical algorithm", Crit Rev Oncol Hematol, 157, pp.103146~ (2021)
- Javadinia SA, "Toxicity of adjuvant radiotherapy in patients with breast cancer : a review study", Rep Radiother Oncol, 5, pp.e89328~ (2018)