Breast-conserving surgery with or without irradiation in women with invasive ductal carcinoma of the breast receiving preoperative systemic therapy: A cohort study.

Abstract

PURPOSE:

To investigate the outcomes of adjuvant whole breast radiation therapy (WBRT) in patients with invasive ductal carcinoma of the breast (breast IDC) receiving preoperative systemic therapy (PST) and breast-conserving surgery (BCS), and their prognostic factors, considering overall survival (OS), locoregional recurrence (LRR), distant metastasis (DM), and disease-free survival.

PATIENTS AND METHODS:

Patients diagnosed as having breast IDC and receiving PST followed by BCS were recruited and categorized by treatment into non-breast radiation therapy [BRT] (control) and WBRT (case) groups, respectively. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs).

RESULTS:

Multivariate Cox regression analyses indicated that non-BRT, cN3, and pathologic residual tumor (ypT2-4) or nodal (ypN2-3) stages were poor prognostic factors for OS. The adjusted HRs (aHRs; 95% CIs) of the WBRT group to non-BRT group for all-cause mortality were 0.14 (0.03-0.81), 0.32 (0.16-0.64), 0.43 (0.23-0.79), 0.23 (0.13-0.42), 0.52 (0.20-1.33), and 0.34 (0.13-0.87) in the ypT0, ypT1, ypT2-4, ypN0, ypN1, and ypN2-3 stages, respectively. The aHRs (95% CIs) of the WBRT group to non-BRT group for all-cause mortality were 0.09 (0.00-4.07), 0.46 (0.26-0.83), 0.18 (0.06-0.51), 0.28 (0.06-1.34), 0.25 (0.10-0.63), 0.47 (0.23-0.88), and 0.32 in the cT0-1, cT2, cT3, cT4, cN0, cN1, and cN2-3 stages, respectively. The WBRT group exhibited significantly better LRR-free and DM-free survival than the non-BRT group, regardless of the clinical T or N stage or pathologic response after PST.

CONCLUSION:

WBRT might lead to superior OS and LRR-free and DM-free survival compared with the non-BRT group, regardless of the initial clinical TN stage or pathologic response.

• Authors: Jiaqiang Zhang, Chang-Yun Lu, Lei Qin, Ho-Min Chen, Szu-Yuan Wu
• Journal: Breast (Edinburgh, Scotland) (Breast) Vol. 54 Pg. 139-147 (Dec 2020) ISSN: 1532-3080 [Electronic] Netherlands
• PMID: 33049657 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Topics

• Adult
• Antineoplastic Protocols
• Breast (pathology)
• Breast Neoplasms (therapy)
• Carcinoma, Ductal, Breast (mortality, therapy)
• Chemotherapy, Adjuvant (methods, mortality)
• Cohort Studies
• Combined Modality Therapy
• Databases, Factual
• Disease-Free Survival
• Female
• Humans
• Lymph Nodes (pathology)
• Mastectomy, Segmental (methods, mortality)
• Middle Aged
• Neoplasm Recurrence, Local (etiology, pathology)
• Neoplasm Staging
• Neoplasm, Residual
• Prognosis
• Proportional Hazards Models
• Radiotherapy, Adjuvant (methods, mortality)
• Registries
• Regression Analysis
• Taiwan
• Treatment Outcome
• Young Adult