Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1-2N1 breast cancer: who can omit adjuvant radiotherapy?

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.

• Authors: Xiaofang Wang, Li Zhang, Xiaomeng Zhang, Jurui Luo, Xuanyi Wang, Xingxing Chen, Zhaozhi Yang, Xin Mei, Xiaoli Yu, Zhen Zhang, Xiaomao Guo, Zhimin Shao, Jinli Ma
• Journal: Breast cancer research and treatment (Breast Cancer Res Treat) Vol. 190 Issue 2 Pg. 277-286 (Nov 2021) ISSN: 1573-7217 [Electronic] Netherlands
• PMID: 34490502 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Topics

• Adult
• Breast Neoplasms (radiotherapy, surgery)
• Female
• Humans
• Lymphatic Metastasis
• Mastectomy
• Neoplasm Recurrence, Local (epidemiology, pathology)
• Neoplasm Staging
• Radiotherapy, Adjuvant