Effect of postoperative radiotherapy after neoadjuvant chemotherapy and modified radical surgery on specific survival of patients with stage cT1–2N1M0 breast cancer: propensity score matching analysis based on SEER database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Meixue , CHEN Jin ,  QUAN Yi

Department of Breast Surgery, The Affiliated Hospital of Southwest Medical University; Sichuan Provincial Center for Gynaecology and Breast Surgery, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

QUAN Yi, Email: 20783833@qq.com

Keywords：

breast cancer; cT1-2N1M0; neoadjuvant chemotherapy; axillary lymph node metastasis; radiotherapy

DOI：

10.7507/1007-9424.202306011

Video：

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Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ²=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ²=0.139, P=0.709; χ²=0.578, P=0.447; χ²=2.617, P=0.106; χ²=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.

Citation： HU Meixue, CHEN Jin, QUAN Yi. Effect of postoperative radiotherapy after neoadjuvant chemotherapy and modified radical surgery on specific survival of patients with stage cT1–2N1M0 breast cancer: propensity score matching analysis based on SEER database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(10): 1224-1231. doi: 10.7507/1007-9424.202306011 Copy

1.	Taylor ME, Haffty BG, Rabinovitch R, et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast. Int J Radiat Oncol Biol Phys, 2009, 73(4): 997-1002.
2.	Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol, 2016, 34(36): 4431-4442.
3.	Wang X, Zhang L, Zhang X, et al. Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1-2N1 breast cancer: who can omit adjuvant radiotherapy?. Breast Cancer Res Treat, 2021, 190(2): 277-286.
4.	NCCN. NCCN clinical practice guidelines in oncology: breast cancer (Version12018). (2018-11-01). 2023-05-05. www. nccn. org/patients.
5.	Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg, 2004, 114(4): 950-960.
6.	陈诚, 谷成, 丁方回, 等. 乳腺癌患者乳房切除术后放射治疗对乳房重建影响的meta分析. 中国普外基础与临床杂志, 2022, 29(1): 78-84.
7.	Kishan AU, McCloskey SA. Postmastectomy radiation therapy after neoadjuvant chemotherapy: review and interpretation of available data. Ther Adv Med Oncol, 2016, 8(1): 85-97.
8.	樊莉, 陈茂山, 牟德武, 等. 基于SEER数据库分析腋窝淋巴结状态与初诊Ⅳ期乳腺癌预后的关系. 遵义医科大学学报, 2021, 44(4): 492-498.
9.	Luo M, Chen H, Deng H, et al. Postmastectomy radiotherapy after neoadjuvant chemotherapy in cT1-2N⁺ breast cancer patients: a single center experience and review of current literature. Front Oncol, 2022, 12: 881047. doi: 10.3389/fonc.2022.881047.
10.	Huang EH, Tucker SL, Strom EA, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol, 2004, 22(23): 4691-4699.
11.	McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1004-1009.
12.	Le Scodan R, Selz J, Stevens D, et al. Radiotherapy for stage Ⅱ and stage Ⅲ breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. Int J Radiat Oncol Biol Phys, 2012, 82(1): e1-e7.
13.	Shim SJ, Park W, Huh SJ, et al. The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage Ⅱ-Ⅲ breast cancer patients with pN0: a multicenter, retrospective study (KROG 12-05). Int J Radiat Oncol Biol Phys, 2014, 88(1): 65-72.
14.	Rusthoven CG, Rabinovitch RA, Jones BL, et al. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol, 2016, 27(5): 818-827.
15.	Cao L, Ou D, Shen KW, et al. Outcome of postmastectomy radiotherapy after primary systemic treatment in patients with clinical T1-2N1 breast cancer. Cancer Radiother, 2018, 22(1): 38-44.
16.	铁剑, 张丝媛. 乳腺癌新辅助化疗后腋窝淋巴结1~3枚转移的患者改良根治术后放射治疗的疗效分析. 中华乳腺病杂志 (电子版), 2015, 9(3): 168-172.
17.	贺春钰, 糟航, 木妮热·木沙江, 等. 新辅助化疗后N0的早期乳腺癌患者术后放疗的临床价值. 实用医学杂志, 2019, 35(17): 2761-2764.
18.	孙丽云, 卢月, 张顺康, 等. cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结转移0~3枚患者术后放疗的生存分析. 国际肿瘤学杂志, 2020, 47(1): 10-17.
19.	Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1-2 patients with one to three positive lymph nodes - past, present and future. Breast, 2019, 48: 73-81.
20.	Abdel-Rahman O. Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1-2 N1 disease : an individual patient data analysis of three clinical trials. Strahlenther Onkol, 2019 , 195(4): 297-305.
21.	Kim SI, Cho SH, Lee JS, et al. Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes. Br J Cancer, 2013, 109(5): 1165-1171.
22.	Park HJ, Shin KH, Kim JH, et al. 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). Cancer Res Treat, 2017, 49(3): 739-747.
23.	Yamada A, Hayashi N, Kumamaru H, et al. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases: a retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer, 2022, 172: 31-40.
24.	杨柯, 李天禹. CD2在乳腺癌肿瘤微环境中的作用及其预后意义. 遵义医科大学学报, 2021, 44(2): 201-211.
25.	Menon H, Chen D, Ramapriyan R, et al. Influence of low-dose radiation on abscopal responses in patients receiving high-dose radiation and immunotherapy. J Immunother Cancer, 2019, 7(1): 237. doi: 10.1186/s40425-019-0718-6.
26.	Herter-Sprie GS, Koyama S, Korideck H, et al. Synergy of radiotherapy and PD-1 blockade in Kras-mutant lung cancer. JCI Insight, 2016, 1(9): e87415. doi: 10.1172/jci.insight.87415.
27.	张佳琪, 贾红燕. PD-1/PD-L1抑制剂在乳腺癌中的研究进展. 中国普外基础与临床杂志, 2021, 28(11): 1530-1535.
28.	Demaria S, Coleman CN, Formenti SC. Radiotherapy: changing the game in immunotherapy. Trends Cancer, 2016, 2 (6): 286-294.
29.	Liu L, Chen W, Zhang R, et al. Radiotherapy in combination with systemic therapies for brain metastases: current status and progress. Cancer Biol Med, 2020, 17(4): 910-922.
30.	蒲虹羽, 高砚春, 侯令密. 乳房切除术后放射治疗在T1~2N1M0患者中的研究进展. 中国普外基础与临床杂志, 2022, 29(10): 1395-1400.

1. Taylor ME, Haffty BG, Rabinovitch R, et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast. Int J Radiat Oncol Biol Phys, 2009, 73(4): 997-1002.
2. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol, 2016, 34(36): 4431-4442.
3. Wang X, Zhang L, Zhang X, et al. Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1-2N1 breast cancer: who can omit adjuvant radiotherapy?. Breast Cancer Res Treat, 2021, 190(2): 277-286.
4. NCCN. NCCN clinical practice guidelines in oncology: breast cancer (Version12018). (2018-11-01). 2023-05-05. www. nccn. org/patients.
5. Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg, 2004, 114(4): 950-960.
6. 陈诚, 谷成, 丁方回, 等. 乳腺癌患者乳房切除术后放射治疗对乳房重建影响的meta分析. 中国普外基础与临床杂志, 2022, 29(1): 78-84.
7. Kishan AU, McCloskey SA. Postmastectomy radiation therapy after neoadjuvant chemotherapy: review and interpretation of available data. Ther Adv Med Oncol, 2016, 8(1): 85-97.
8. 樊莉, 陈茂山, 牟德武, 等. 基于SEER数据库分析腋窝淋巴结状态与初诊Ⅳ期乳腺癌预后的关系. 遵义医科大学学报, 2021, 44(4): 492-498.
9. Luo M, Chen H, Deng H, et al. Postmastectomy radiotherapy after neoadjuvant chemotherapy in cT1-2N⁺ breast cancer patients: a single center experience and review of current literature. Front Oncol, 2022, 12: 881047. doi: 10.3389/fonc.2022.881047.
10. Huang EH, Tucker SL, Strom EA, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol, 2004, 22(23): 4691-4699.
11. McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1004-1009.
12. Le Scodan R, Selz J, Stevens D, et al. Radiotherapy for stage Ⅱ and stage Ⅲ breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. Int J Radiat Oncol Biol Phys, 2012, 82(1): e1-e7.
13. Shim SJ, Park W, Huh SJ, et al. The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage Ⅱ-Ⅲ breast cancer patients with pN0: a multicenter, retrospective study (KROG 12-05). Int J Radiat Oncol Biol Phys, 2014, 88(1): 65-72.
14. Rusthoven CG, Rabinovitch RA, Jones BL, et al. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol, 2016, 27(5): 818-827.
15. Cao L, Ou D, Shen KW, et al. Outcome of postmastectomy radiotherapy after primary systemic treatment in patients with clinical T1-2N1 breast cancer. Cancer Radiother, 2018, 22(1): 38-44.
16. 铁剑, 张丝媛. 乳腺癌新辅助化疗后腋窝淋巴结1~3枚转移的患者改良根治术后放射治疗的疗效分析. 中华乳腺病杂志 (电子版), 2015, 9(3): 168-172.
17. 贺春钰, 糟航, 木妮热·木沙江, 等. 新辅助化疗后N0的早期乳腺癌患者术后放疗的临床价值. 实用医学杂志, 2019, 35(17): 2761-2764.
18. 孙丽云, 卢月, 张顺康, 等. cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结转移0~3枚患者术后放疗的生存分析. 国际肿瘤学杂志, 2020, 47(1): 10-17.
19. Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1-2 patients with one to three positive lymph nodes - past, present and future. Breast, 2019, 48: 73-81.
20. Abdel-Rahman O. Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1-2 N1 disease : an individual patient data analysis of three clinical trials. Strahlenther Onkol, 2019 , 195(4): 297-305.
21. Kim SI, Cho SH, Lee JS, et al. Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes. Br J Cancer, 2013, 109(5): 1165-1171.
22. Park HJ, Shin KH, Kim JH, et al. 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). Cancer Res Treat, 2017, 49(3): 739-747.
23. Yamada A, Hayashi N, Kumamaru H, et al. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases: a retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer, 2022, 172: 31-40.
24. 杨柯, 李天禹. CD2在乳腺癌肿瘤微环境中的作用及其预后意义. 遵义医科大学学报, 2021, 44(2): 201-211.
25. Menon H, Chen D, Ramapriyan R, et al. Influence of low-dose radiation on abscopal responses in patients receiving high-dose radiation and immunotherapy. J Immunother Cancer, 2019, 7(1): 237. doi: 10.1186/s40425-019-0718-6.
26. Herter-Sprie GS, Koyama S, Korideck H, et al. Synergy of radiotherapy and PD-1 blockade in Kras-mutant lung cancer. JCI Insight, 2016, 1(9): e87415. doi: 10.1172/jci.insight.87415.
27. 张佳琪, 贾红燕. PD-1/PD-L1抑制剂在乳腺癌中的研究进展. 中国普外基础与临床杂志, 2021, 28(11): 1530-1535.
28. Demaria S, Coleman CN, Formenti SC. Radiotherapy: changing the game in immunotherapy. Trends Cancer, 2016, 2 (6): 286-294.
29. Liu L, Chen W, Zhang R, et al. Radiotherapy in combination with systemic therapies for brain metastases: current status and progress. Cancer Biol Med, 2020, 17(4): 910-922.
30. 蒲虹羽, 高砚春, 侯令密. 乳房切除术后放射治疗在T1~2N1M0患者中的研究进展. 中国普外基础与临床杂志, 2022, 29(10): 1395-1400.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of postoperative radiotherapy after neoadjuvant chemotherapy and modified radical surgery on specific survival of patients with stage cT1–2N1M0 breast cancer: propensity score matching analysis based on SEER database

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