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. 2025 May 8:15:1489390.
doi: 10.3389/fonc.2025.1489390. eCollection 2025.

Effect of post-mastectomy radiation therapy on survival in breast cancer with lymph nodes micrometastases: a meta-analysis and systematic review

Jianqing Zheng #  1 , Bifen Huang #  2 , Ying Chen #  1 , Zhangzhu Chen #  3
Affiliations

Effect of post-mastectomy radiation therapy on survival in breast cancer with lymph nodes micrometastases: a meta-analysis and systematic review

Jianqing Zheng et al. Front Oncol. .

Abstract

Background: Axillary management of patients with early-stage breast cancer (ESBC) has evolved, especially with the implementation of precision radiotherapy techniques that have resulted in a significant reduction in treatment-related toxicities, but it is unclear whether post-mastectomy radiotherapy (PMRT) improves survival outcomes in breast cancer with lymph nodes micrometastases (BCLNMM, that is T0, T1 ~2NmiM0). Our study is to systematically evaluate the effect of PMRT on survival in breast cancer with lymph nodes micrometastases.

Methods: A literature search was performed for randomized controlled trials (RCTs) or retrospective studies related to PMRT versus non-post-mastectomy radiotherapy (non-PMRT) in the adjuvant treatment of ESBC in PubMed, Cochrane Library, Embase, CNKI and other databases. R package meta software was used to perform meta-analyses with hazard ratio (HR). Newcastle Ottawa scale was selected for quality assessment. The review was prospectively registered on PROSPERO (CRD42024562444).

Results: 10 relevant studies were screened, all of which were retrospective studies. The difference in overall survival (OS) was not statistically significant (HR = 0.92, 95%CI: 0.81 ~ 1.04; Z = 1.35, P = 0.177). The difference in breast cancer-specific survival (BCSS) between the PMRT group and the non-PMRT group was not statistically significant HR = 1.18, 95%CI: 0.94 ~ 1.48; Z = 1.41, P =0.160). The difference in disease-free survival (DFS) was statistically significant (HR = 0.47, 95%CI: 0.23 ~ 1.00; Z = 1.96, P =0.049). The difference in local recurrence free survival (LRRFS) was also not statistically significant (HR = 0.50, 95%CI: 0.11 ~ 2.26, P = 0.190). The difference in distant-metastasis free survival (DMFS) was not statistically significant (HR = 0.54, 95%CI: 0.22 ~ 1.35, P = 0.356).

Conclusions: Despite the tendency of PMRT in BCLNMM to improve DFS, OS, BCSS, LRRFS, and DMFS showed no benefit, therefore, PMRT should be used with caution in BCLNMM.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024562444.

Keywords: axillary lymph node dissection; breast cancer; lymph nodal micrometastasis; meta-analysis; radiotherapy; sentinel lymph node biopsy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Trials selection flow chart of the meta-analysis.
Figure 2
Figure 2
Meta-analysis results of different survival outcome. (A) overall survival, (B) breast cancer-specific survival, (C) disease-free survival, (D) local recurrence free survival and (E) distant-metastasis free survival.
Figure 3
Figure 3
Analysis of publication bias with bias funnel plots. (A) overall survival, (B) breast cancer-specific survival.
Figure 4
Figure 4
Sensitivity analysis results of overall survival and breast cancer-specific survival. (A) overall survival, (B) breast cancer-specific survival.
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References

    1. Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast cancer-epidemiology, risk factors, classification, prognostic markers, and current treatment strategies-an updated review. Cancers (Basel). (2021) 13:1–30. doi: 10.3390/cancers13174287 - DOI - PMC - PubMed
    1. Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. (2022) 95:20211033. doi: 10.1259/bjr.20211033 - DOI - PMC - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2021) 71:209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). (2021) 134:783–91. doi: 10.1097/cm9.0000000000001474 - DOI - PMC - PubMed
    1. Xia C, Dong X, Li H, Cao M, Sun D, He S, et al. . Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). (2022) 135:584–90. doi: 10.1097/cm9.0000000000002108 - DOI - PMC - PubMed

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