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. 2018 Oct 2:10:4105-4112.
doi: 10.2147/CMAR.S173628. eCollection 2018.

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Xin Wang  1 , Liming Xu  1 , Zhenzhen Yin  1 , Daquan Wang  1 , Qi Wang  1 , Kunpeng Xu  1 , Jinlin Zhao  1 , Lujun Zhao  1 , Zhiyong Yuan  1 , Ping Wang  1
Affiliations

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Xin Wang et al. Cancer Manag Res. .

Abstract

Objective: In order to identify risk factors associated with locoregional recurrence (LRR) and assess the role of postmastectomy radiotherapy (PMRT) in early breast cancer (BC), managed with neoadjuvant chemotherapy (NAC) and mastectomy, a retrospective analysis of BC diagnosed with clinical stage T1-2N0-1 was conducted.

Patients and methods: A total of 217 patients were included in this analysis. The median age was 50 years (24-72 years). The clinical stage distributions were cT1 in 15 cases, cT2 in 202, cN0 in 53, and cN1 in 161 cases. All patients were treated with NAC and mastectomy, and 128 patients received PMRT.

Results: With a median follow-up time of 61 months, the 5-year cumulative LRR rate was 12%. Multivariate analysis demonstrated that pathological N stage, lymph-vascular invasion, and histological grade were independent prognostic factors associated with LRR. A nomogram model based on these factors was established, based on which the patients were deeply stratified into low- and high-risk group. In the low-risk group, radiotherapy did not decrease LRR (3.3% in PMRT group, 1.7% in no PMRT group, P=0.192). While in the high-risk group, PMRT significantly decreased LRR (21.8% in PMRT group, 42.2% in no PMRT group, P=0.031).

Conclusion: Lymph-vascular invasion, histological grade, as well as pathological N stage were important prognostic factors associated with LRR in BC patients staged in cT1-2N0-1, who were managed with NAC and mastectomy. In our cohort, not only clinical and pathological stage information but also other risk factors were taken into consideration when adjuvant PMRT was recommended. In the high-risk subgroup, PMRT significantly improved the prognosis.

Keywords: breast cancer; neoadjuvant chemotherapy; postmastectomy radiotherapy; prognosis.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Survival curves of the whole cohort of patients; (B) failure pattern of the whole cohort of patients. Abbreviation: LRFS, locoregional recurrence-free survival; DMFS, distant metastasis free survival; DFS, disease free survival; LR, local recurrence; RR, regional recurrence; DM, distant metastasis.
Figure 2
Figure 2
(A) LRR rates of patients in ypN0, ypN1, and ypN2–3; (B) LRR rates of patients with or without LVI; (C) LRR rates of patients with or without histological grade 3. Abbreviations: LRR, locoregional recurrence; LVI, lymph-vascular invasion.
Figure 3
Figure 3
(A) A nomogram model was established according to our dataset. (B) The LRR curves in low- and high-risk group treated with or without PMRT. Abbreviations: LRR, locoregional recurrence; PMRT, postmastectomy radiotherapy, LRFS, locoregional recurrence-free survival.
See this image and copyright information in PMC

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