Departments of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Departments of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA.
Ann Surg Oncol. 2018 Aug;25(8):2288-2295. doi: 10.1245/s10434-018-6565-8. Epub 2018 Jun 18.
A meta-analysis of 22 randomized trials accrued from 1964 to 1986 demonstrated significantly higher rates of locoregional failure (LRF) and breast-cancer mortality in women with 1-3 positive nodes without postmastectomy radiotherapy (PMRT) after mastectomy (mast.). Recent data demonstrate that PMRT reduces distant metastases (DM) in women with pN1 disease. The challenge today is whether all patients with pathologic T1-2pN1 disease have similar substantial LRF/DM risk that routinely warrants PMRT.
We reviewed patients with pT1-2N1 breast cancer treated with mast. ± adjuvant systemic therapy without PMRT from 2000 to 2013. The endpoints were LRF and DM rates, estimated by cumulative incidence method.
We identified 468 patients with median follow-up of 6.3 years. Most (71%) were estrogen receptor/progesterone receptor + human epidermal growth factor receptor 2 (HER2). There were 269 patients with 1+ node, 140 patients with 2+ nodes, and 59 patients with 3+ nodes. The 6-year LRF/DM rates were 4.1%/8.4%. Patients with 1+, 2+, and 3+ nodes had 6-year LRF of 2.3, 5.1 and 8.9%, respectively (p = 0.13). The 6-year DM rate was higher in patients with 3+ nodes versus 1-2+ nodes: 15.7% versus 7.4% (p = 0.02). Several subgroups had low 6-year LRF and DM rates, including T1/1+ node (0.8%/4.1% LRF/DM) and micrometastases (0%/5.8% LRF/DM).
Patients with pT1-2pN1 represent a heterogeneous group with a wide range of LRF/DM rates. In particular, patients with pT1 tumors and 1 + LN, and patients with micrometastases, had low event rates. These groups would derive small absolute reductions in LRF and DM with addition of PMRT, underscoring the importance of patient selection for PMRT in pT1-2pN1 breast cancer.
1964 年至 1986 年期间积累的 22 项随机试验的荟萃分析表明，在接受乳房切除术（mast.）后未接受乳房切除术后放疗（PMRT）的 1-3 个阳性淋巴结的女性中，局部区域复发（LRF）和乳腺癌死亡率显著更高。最近的数据表明，PMRT 可降低 pN1 疾病女性的远处转移（DM）。目前的挑战是，所有病理 T1-2pN1 疾病患者是否具有相似的重大 LRF/DM 风险，通常需要 PMRT。
我们回顾了 2000 年至 2013 年期间接受乳房切除术±辅助全身治疗且未接受 PMRT 的 pT1-2N1 乳腺癌患者。终点是 LRF 和 DM 发生率，通过累积发生率法估计。
我们确定了 468 名中位随访 6.3 年的患者。大多数（71%）为雌激素受体/孕激素受体+人表皮生长因子受体 2（HER2）阳性。1+淋巴结患者 269 例，2+淋巴结患者 140 例，3+淋巴结患者 59 例。6 年 LRF/DM 发生率分别为 4.1%/8.4%。1+、2+和 3+淋巴结患者的 6 年 LRF 分别为 2.3%、5.1%和 8.9%（p=0.13）。3+淋巴结患者的 6 年 DM 发生率高于 1-2+淋巴结患者：15.7%比 7.4%（p=0.02）。包括 T1/1+淋巴结（LRF/DM 分别为 0.8%/4.1%）和微转移（LRF/DM 分别为 0%/5.8%）在内的几个亚组的 6 年 LRF 和 DM 发生率较低。
pT1-2pN1 患者代表一组具有广泛 LRF/DM 发生率的异质群体。特别是，pT1 肿瘤和 1+LN 患者以及微转移患者的事件发生率较低。这些组通过添加 PMRT 可使 LRF 和 DM 的绝对减少量较小，突出了在 pT1-2pN1 乳腺癌中选择患者进行 PMRT 的重要性。
