The role of postmastectomy radiotherapy in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes after neoadjuvant chemotherapy: an analysis from the NCDB
Identifieur interne : 001699 ( Main/Exploration ); précédent : 001698; suivant : 001700The role of postmastectomy radiotherapy in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes after neoadjuvant chemotherapy: an analysis from the NCDB
Auteurs : Jieqiong Liu [République populaire de Chine, États-Unis] ; Kai Mao [République populaire de Chine, États-Unis] ; Shuai Jiang [États-Unis] ; Wen Jiang [États-Unis] ; Kai Chen [République populaire de Chine, États-Unis] ; Betty Y. S. Kim [États-Unis] ; Qiang Liu [République populaire de Chine] ; Lisa K. Jacobs [États-Unis]Source :
- Oncotarget [ 1949-2553 ] ; 2015.
Abstract
The role of postmastectomy radiotherapy (PMRT) in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains controversial.
A total of 1560 clinically node-positive, stage II-III breast cancer patients treated with NAC and mastectomy who achieved ypN0 between 1998 and 2009 in the National Cancer Database were analyzed. The effects of PMRT on overall survival (OS) for the entire cohort and multiple subgroups were evaluated. Imputation and propensity score matching were used as sensitivity analyses to minimize biases.
Of the entire 1560 eligible patients, 903 (57.9%) received PMRT and 657 (42.1%) didn’t. At a median follow-up of 56.0 months, no statistical difference was observed for OS between two groups by univariate and multivariate analyses (
This study demonstrated that PMRT showed a heterogeneous effect in clinically node-positive, stage II-III breast cancer patients with ypN0 following NAC. PMRT improved OS for patients with clinical stage IIIB/IIIC disease, T3/T4 tumor, or residual invasive breast tumor after NAC. In the absence of definitive conclusions from prospective studies, including the ongoing NSABP B-51 trial, our findings may help identify specific groups of women with clinically node-positive, stage II-III breast cancers who could benefit from PMRT after NAC.
Url:
DOI: 10.18632/oncotarget.6664
PubMed: 26709538
PubMed Central: 5029747
Affiliations:
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Kim</name><affiliation wicri:level="1"><nlm:aff id="A7"> Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL</wicri:regionArea><wicri:noRegion>FL</wicri:noRegion></affiliation></author><author><name sortKey="Liu, Qiang" sort="Liu, Qiang" uniqKey="Liu Q" first="Qiang" last="Liu">Qiang Liu</name><affiliation wicri:level="3"><nlm:aff id="A1"> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation></author><author><name sortKey="Jacobs, Lisa K" sort="Jacobs, Lisa K" uniqKey="Jacobs L" first="Lisa K." last="Jacobs">Lisa K. Jacobs</name><affiliation wicri:level="1"><nlm:aff id="A2"> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26709538</idno><idno type="pmc">5029747</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029747</idno><idno type="RBID">PMC:5029747</idno><idno type="doi">10.18632/oncotarget.6664</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">004258</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004258</idno><idno type="wicri:Area/Pmc/Curation">004257</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004257</idno><idno 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Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="A2"> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author><author><name sortKey="Mao, Kai" sort="Mao, Kai" uniqKey="Mao K" first="Kai" last="Mao">Kai Mao</name><affiliation wicri:level="3"><nlm:aff id="A3"> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of General Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of General Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="A4"> Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author><author><name sortKey="Jiang, Shuai" sort="Jiang, Shuai" uniqKey="Jiang S" first="Shuai" last="Jiang">Shuai Jiang</name><affiliation wicri:level="1"><nlm:aff id="A5"> Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author><author><name sortKey="Jiang, Wen" sort="Jiang, Wen" uniqKey="Jiang W" first="Wen" last="Jiang">Wen Jiang</name><affiliation wicri:level="1"><nlm:aff id="A6"> Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX</wicri:regionArea><wicri:noRegion>TX</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Kai" sort="Chen, Kai" uniqKey="Chen K" first="Kai" last="Chen">Kai Chen</name><affiliation wicri:level="3"><nlm:aff id="A1"> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="A2"> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Betty Y S" sort="Kim, Betty Y S" uniqKey="Kim B" first="Betty Y. S." last="Kim">Betty Y. S. Kim</name><affiliation wicri:level="1"><nlm:aff id="A7"> Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL</wicri:regionArea><wicri:noRegion>FL</wicri:noRegion></affiliation></author><author><name sortKey="Liu, Qiang" sort="Liu, Qiang" uniqKey="Liu Q" first="Qiang" last="Liu">Qiang Liu</name><affiliation wicri:level="3"><nlm:aff id="A1"> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea> Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation></author><author><name sortKey="Jacobs, Lisa K" sort="Jacobs, Lisa K" uniqKey="Jacobs L" first="Lisa K." last="Jacobs">Lisa K. Jacobs</name><affiliation wicri:level="1"><nlm:aff id="A2"> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea> Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD</wicri:regionArea><wicri:noRegion>MD</wicri:noRegion></affiliation></author></analytic><series><title level="j">Oncotarget</title><idno type="eISSN">1949-2553</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>The role of postmastectomy radiotherapy (PMRT) in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains controversial.</p></sec><sec><title>Methods</title><p>A total of 1560 clinically node-positive, stage II-III breast cancer patients treated with NAC and mastectomy who achieved ypN0 between 1998 and 2009 in the National Cancer Database were analyzed. The effects of PMRT on overall survival (OS) for the entire cohort and multiple subgroups were evaluated. Imputation and propensity score matching were used as sensitivity analyses to minimize biases.</p></sec><sec><title>Results</title><p>Of the entire 1560 eligible patients, 903 (57.9%) received PMRT and 657 (42.1%) didn’t. At a median follow-up of 56.0 months, no statistical difference was observed for OS between two groups by univariate and multivariate analyses (<italic>P</italic> = 0.120; HR 1.571, 95% CI 0.839-2.943). On subgroup analyses, PMRT significantly improved OS in patients with clinical stage IIIB/IIIC disease, T3/T4 tumor, or residual invasive breast cancer after NAC (<italic>P</italic> < 0.05). This improvement in OS remained significant after sensitivity analyses for the propensity score-matched patients.</p></sec><sec><title>Conclusions</title><p>This study demonstrated that PMRT showed a heterogeneous effect in clinically node-positive, stage II-III breast cancer patients with ypN0 following NAC. PMRT improved OS for patients with clinical stage IIIB/IIIC disease, T3/T4 tumor, or residual invasive breast tumor after NAC. In the absence of definitive conclusions from prospective studies, including the ongoing NSABP B-51 trial, our findings may help identify specific groups of women with clinically node-positive, stage II-III breast cancers who could benefit from PMRT after NAC.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kyndi, M" uniqKey="Kyndi M">M Kyndi</name></author><author><name sortKey="Sorensen, Fb" uniqKey="Sorensen F">FB Sorensen</name></author><author><name sortKey="Knudsen, H" uniqKey="Knudsen H">H Knudsen</name></author><author><name sortKey="Overgaard, M" uniqKey="Overgaard M">M Overgaard</name></author><author><name sortKey="Nielsen, Hm" uniqKey="Nielsen H">HM Nielsen</name></author><author><name sortKey="Overgaard, J" uniqKey="Overgaard J">J Overgaard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goldhirsch, A" uniqKey="Goldhirsch A">A Goldhirsch</name></author><author><name 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uniqKey="Schechter N">NR Schechter</name></author><author><name sortKey="Hunt, Kk" uniqKey="Hunt K">KK Hunt</name></author><author><name sortKey="Sahin, Aa" uniqKey="Sahin A">AA Sahin</name></author><author><name sortKey="Buchholz, Ta" uniqKey="Buchholz T">TA Buchholz</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>République populaire de Chine</li><li>États-Unis</li></country><region><li>Guangdong</li></region><settlement><li>Jiangmen</li></settlement></list><tree><country name="République populaire de Chine"><region name="Guangdong"><name sortKey="Liu, Jieqiong" sort="Liu, Jieqiong" uniqKey="Liu J" first="Jieqiong" last="Liu">Jieqiong Liu</name></region><name sortKey="Chen, Kai" sort="Chen, Kai" uniqKey="Chen K" first="Kai" last="Chen">Kai Chen</name><name sortKey="Liu, Qiang" sort="Liu, Qiang" uniqKey="Liu Q" first="Qiang" last="Liu">Qiang Liu</name><name sortKey="Mao, Kai" sort="Mao, Kai" uniqKey="Mao K" first="Kai" last="Mao">Kai Mao</name></country><country name="États-Unis"><noRegion><name sortKey="Liu, Jieqiong" sort="Liu, Jieqiong" uniqKey="Liu J" first="Jieqiong" last="Liu">Jieqiong Liu</name></noRegion><name sortKey="Chen, Kai" sort="Chen, Kai" uniqKey="Chen K" first="Kai" last="Chen">Kai Chen</name><name sortKey="Jacobs, Lisa K" sort="Jacobs, Lisa K" uniqKey="Jacobs L" first="Lisa K." last="Jacobs">Lisa K. Jacobs</name><name sortKey="Jiang, Shuai" sort="Jiang, Shuai" uniqKey="Jiang S" first="Shuai" last="Jiang">Shuai Jiang</name><name sortKey="Jiang, Wen" sort="Jiang, Wen" uniqKey="Jiang W" first="Wen" last="Jiang">Wen Jiang</name><name sortKey="Kim, Betty Y S" sort="Kim, Betty Y S" uniqKey="Kim B" first="Betty Y. S." last="Kim">Betty Y. S. Kim</name><name sortKey="Mao, Kai" sort="Mao, Kai" uniqKey="Mao K" first="Kai" last="Mao">Kai Mao</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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