Incorporating Risk Factors to Identify the Indication of Post-mastectomy Radiotherapy in N1 Breast Cancer Treated with Optimal Systemic Therapy: A Multicenter Analysis in Korea (KROG 14-23)
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Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.
Abstract
Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.
참고문헌 (21)
- Coates AS, "Tailoring therapies : improving the management of early breast cancer : St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015", Ann Oncol, 26, pp.1533~1546 (2015)
- Gradishar WJ, "Invasive Breast Cancer Version 1.2016, NCCN Clinical Practice Guidelines in Oncology", J Natl Compr Canc Netw, 14, pp.324~354 (2016)
- 강진규, "The clinical utilization of radiation therapy in Korea between 2009 and 2013", Radiation oncology journal, 34(2), pp.88~95 (2016), 대한방사선종양학회
- Recht A, "Postmastectomy radiotherapy : clinical practice guidelines of the American Society of Clinical Oncology", J Clin Oncol, 19, pp.1539~1569 (2001)
- EBCTCG(Early Breast Cancer Trialists' Collaborative Group), "Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality : metaanalysis of individual patient data for 8135 women in 22 randomised trials", Lancet, 383, pp.2127~2135 (2014)
- Overgaard M, "Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials", Radiother Oncol, 82, pp.247~253 (2007)
- Jatoi I, "Breast cancer adjuvant therapy : time to consider its time-dependent effects", J Clin Oncol, 29, pp.2301~2304 (2011)
- Perou CM, "Molecular portraits of human breast tumours", Nature, 406, pp.747~752 (2000)
- Sorlie T, "Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications", Proc Natl Acad Sci U S A, 98, pp.10869~10874 (2001)
- Early Breast Cancer Trialists' Collaborative Group(EBCTCG), "Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival : an overview of the randomised trials", Lancet, 365, pp.1687~1717 (2005)
- Goldhirsch A, "Strategies for subtypes: dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011", Ann Oncol, 22, pp.1736~1747 (2011)
- Lai SF, "Locoregional recurrence risk for postmastectomy breast cancer patients With T1-2 and one to three positive lymph nodes receiving modern systemic treatment without radiotherapy", Ann Surg Oncol, 23, pp.3860~3869 (2016)
- Early Breast Cancer Trialists' Collaborative Group(EBCTCG), "Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen : patient-level meta-analysis of randomised trials", Lancet, 378, pp.771~784 (2011)
- Early Breast Cancer Trialists' Collaborative Group(EBCTCG), "Comparisons between different polychemotherapy regimens for early breast cancer : meta-analyses of long-term outcome among 100, 000 women in 123 randomised trials", Lancet, 379, pp.432~444 (2012)
- Kyndi M, "Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer : the Danish Breast Cancer Cooperative Group", J Clin Oncol, 26, pp.1419~1426 (2008)
- Lowery AJ, "Locoregional recurrence after breast cancer surgery : a systematic review by receptor phenotype", Breast Cancer Res Treat, 133, pp.831~841 (2012)
- Sotiriou C, "Breast cancer classification and prognosis based on gene expression profiles from a population-based study", Proc Natl Acad Sci U S A, 100, pp.10393~10398 (2003)
- Tseng YD, "Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database", Int J Radiat Oncol Biol Phys, 93, pp.622~630 (2015)
- Voduc KD, "Breast cancer subtypes and the risk of local and regional relapse", J Clin Oncol, 28, pp.1684~1691 (2010)
- Jwa E, "Identification of risk factors for locoregional recurrence in breast cancer patients with nodal stage N0 and N1: who could benefit from post-mastectomy radiotherapy", PLoS One, 10, pp.e0145463~ (2015)
- Kunkler IH, "Elucidating the role of chest wall irradiation in 'intermediate-risk'breast cancer: the MRC", EORTC SUPREMO trial, 2008, pp.20, 31~34