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

Autor: Lei Qin, Chang-Yun Lu, Jiaqiang Zhang, Ho-Min Chen, Szu-Yuan Wu
Rok vydání: 2020
Předmět:
Oncology
Neoplasm
Residual
Databases
Factual
Survival
ER
estrogen receptor
medicine.medical_treatment
LRR
locoregional recurrence
Mastectomy
Segmental
cT
clinical tumor stages
Cohort Studies
TM
total mastectomy
Breast cancer
0302 clinical medicine
WBRT
whole breast radiation therapy
Breast-conserving surgery
HER2
human epidermal growth factor receptor 2
Breast
Registries
030212 general & internal medicine
Stage (cooking)
Preoperative systemic therapy
ALND
axillary lymph node dissection
DM
distant metastasis
PST
preoperative systemic therapy
CCI
Charlson comorbidity index
Carcinoma
Ductal
Breast
Hazard ratio
RT
radiation therapy
General Medicine
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Prognosis
Combined Modality Therapy
pCR
pathological complete response
BRT
breast radiation therapy
Treatment Outcome
Chemotherapy
Adjuvant
TCRD
Taiwan Cancer Registry database
IIT
intention-to-treat
030220 oncology & carcinogenesis
AJCC
American Joint Committee on Cancer
Regression Analysis
Female
Original Article
Cohort study
Adult
medicine.medical_specialty
Whole breast radiation therapy
Taiwan
Breast Neoplasms
N
nodal
cN
clinical nodal stages
ypT
pathological tumor stages after preoperative systemic therapy
lcsh:RC254-282
Disease-Free Survival
OS
overall survival
Young Adult
03 medical and health sciences
ICD-9-CM
International Classification of Diseases
Ninth Revision
Clinical Modification
SNLB
sentinel lymph node biopsy
Internal medicine
Stages
medicine
Humans
Neoplasm Staging
Proportional Hazards Models
IDC
invasive intraductal carcinoma
Proportional hazards model
business.industry
Antineoplastic Protocols
ypN
pathological nodal stages after preoperative systemic therapy
PR
progesterone receptor
T
tumor
HRs
hazard ratios
medicine.disease
CIs
confidence intervals
Confidence interval
Radiation therapy
Radiotherapy
Adjuvant
Surgery
Lymph Nodes
Neoplasm Recurrence
Local
BCS
breast-conserving surgery
business
Zdroj: The Breast : Official Journal of the European Society of Mastology
Breast, Vol 54, Iss, Pp 139-147 (2020)
ISSN: 0960-9776
DOI: 10.1016/j.breast.2020.09.010
Popis: 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.
Highlights • Outcome patterns of adjuvant RT for patients with breast cancer receiving preoperative systemic therapy and breast-conserving surgery. • Non-breast radiation therapy, cN3, pathologic residual tumor (ypT2–4), or nodal (ypN2–3) stages are poor prognostic factors for survival. • The beneficial effects of RT are superior OS and LRR-free and DM-free survival compared with the non-RT group.
Databáze: OpenAIRE
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