Department of Head and Neck Oncology, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Cancer Med. 2023 Apr;12(7):8112-8121. doi: 10.1002/cam4.5610. Epub 2023 Feb 3.
The prognosis and the value of postmastectomy radiotherapy (PMRT) between post-chemotherapy ypT1-2ypN1 and de novo pT1-2N1 breast cancer (BC) remain controversial. We aimed to evaluate the prognostic differences and the effect of PMRT between the two patient subsets.
Patients diagnosed with pT1-2N1M0 BC were identified between 2010 and 2018. The study endpoints were overall survival (OS), breast cancer-specific survival (BCSS), locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and disease-free survival (DFS). The chi-square test, Kaplan-Meier method and Cox regression analysis were used for data analysis.
Total number of 2103 pT1-2N1M0 BC patients were included in the study, including 270 post-chemotherapy (97 without PMRT, 173 with PMRT) and 1833 de novo cases (993 without PMRT, 840 with PMRT). No significant differences were found between post-chemotherapy ypT1-2ypN1 and de novo pT1-2N1 BC patients in 5-year OS (p = 0.068), BCSS (p = 0.054), LRFS (p = 0.241), DMFS (p = 0.104) or DFS (p = 0.08). PMRT did not improve any survival outcome in patients receiving neoadjuvant chemotherapy; however, the PMRT group had a better 5-year BCSS (97.0% vs. 95.8%, p = 0.033) in de novo pT1-2N1 BC. Cox multivariate analysis demonstrated that PMRT was a significant independent predictor of BCSS (HR 0.628; 95% CI, 0.403-0.978; p = 0.04) in de novo pT1-2N1 patients.
There seemed no survival difference in post-chemotherapy ypT1-2ypN1 and de novo pT1-2N1 BC patients with contemporary systemic therapy. In addition, PMRT might be exempted in patients with post-chemotherapy ypT1-2ypN1 BC, while not in patients with de novo pT1-2N1 BC.
化疗后 ypT1-2ypN1 和新诊断的 pT1-2N1 乳腺癌（BC）患者的术后放疗（PMRT）的预后和价值仍存在争议。我们旨在评估这两组患者的预后差异和 PMRT 的效果。
在 2010 年至 2018 年期间，确定了诊断为 pT1-2N1M0BC 的患者。研究终点为总生存（OS）、乳腺癌特异性生存（BCSS）、局部区域无复发生存（LRFS）、无远处转移生存（DMFS）和无病生存（DFS）。采用卡方检验、Kaplan-Meier 法和 Cox 回归分析进行数据分析。
共有 2103 例 pT1-2N1M0BC 患者纳入本研究，其中 270 例为化疗后（97 例未行 PMRT，173 例行 PMRT），1833 例为新诊断（993 例未行 PMRT，840 例行 PMRT）。在 5 年 OS（p=0.068）、BCSS（p=0.054）、LRFS（p=0.241）、DMFS（p=0.104）或 DFS（p=0.08）方面，化疗后 ypT1-2ypN1 和新诊断的 pT1-2N1BC 患者之间无显著差异。新辅助化疗患者接受 PMRT 并未改善任何生存结局，但新诊断的 pT1-2N1BC 患者中 PMRT 组的 5 年 BCSS 更好（97.0%比 95.8%，p=0.033）。Cox 多因素分析表明，PMRT 是新诊断的 pT1-2N1 患者 BCSS 的显著独立预测因子（HR 0.628；95%CI，0.403-0.978；p=0.04）。
在接受当代系统治疗的化疗后 ypT1-2ypN1 和新诊断的 pT1-2N1BC 患者中，似乎生存无差异。此外，在化疗后 ypT1-2ypN1BC 患者中可以免除 PMRT，而在新诊断的 pT1-2N1BC 患者中则不可以。
