A Prognostic Risk Stratification Model to Identify Potential Population Benefiting From Postmastectomy Radiotherapy in T1–2 Breast Cancer With 1–3 Positive Axillary Lymph Nodes

Abstract

Background and ObjectivesTo establish a prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive lymph nodes to determine which patients can benefit from postmastectomy radiotherapy (PMRT).MethodsA population-based study was conducted utilizing data collected from the Surveillance, Epidemiology, and End Results database. Chi-square test or Fisher exact test was used to compare the distribution of characteristics. Cox analysis identified significant prognostic factors for survival. A prognostic stratification model was constructed by R software. Propensity score matching was applied to balance characteristics between PMRT cohort and control cohort. Kaplan-Meier method was performed to evaluate the performance of stratification and the benefits of PMRT in the total population and three risk groups.ResultsThe overall performance of the nomogram was good (3-year, 5-year, 10-year AUC were 0.75, 0.72 and 0.67, respectively). The nomogram was performed to excellently distinguish low-risk, moderate-risk, and high-risk groups with 10-year overall survival (OS) of 86.9%, 73.7%, and 62.7%, respectively (P<0.001). In the high-risk group, PMRT can significantly better OS with 10-year all-cause mortality reduced by 6.7% (P = 0.027). However, there was no significant survival difference between PMRT cohort and control cohort in low-risk (P=0.49) and moderate-risk groups (P = 0.35).ConclusionThe current study developed the first prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive axillary lymph nodes and found that patients in the high-risk group may be easier to benefit from PMRT.

Development and validation of nomograms for predicting survival outcomes in patients with T1-2N1 breast cancer to identify those who could not benefit from postmastectomy radiotherapy

“…Several retrospective series have found that young patients with T1-2N1 breast cancer have a worse prognosis ( 5 , 20 , 26 , 27 ). However, our analysis demonstrated that patients aged ≥70 years old had worse OS and BCSS, and this finding was similar to that of several previous studies ( 4 , 29 – 31 ). Hence, the influence of age on the survival of patients with T1-2N1 breast cancer remains controversial, and this observation cannot be explained solely by the higher all-cause mortality rate in patients over 70 years of age.…”

“…Married patients are able to receive more mental and financial support and demonstrate better compliance. Similar findings have recently been reported in patients with T1-2N1 breast cancer ( 4 ). Given the current research situation, we included marital status in the models to explore the relationship between marital status and survival.…”

“…Accumulated evidence has confirmed that the effectiveness of PMRT is heterogeneous among patients with T1-2N1 breast cancer ( 3 ). Therefore, selecting which patients with 1 to 3 positive lymph nodes are suitable for radiotherapy is a current issue being explored by many scholars ( 4 – 7 ). Such a problem has also attracted widespread attention in the field of breast cancer, with many studies attempting to find appropriate methods to solve the above problem.…”

A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1–2HR+ breast cancer

“…However, when limited positive SLN were observed, the best treatment for the armpit depends. Based on ACSOG Z0011, AMAROS and OTOASOR study, axillary recurrence (RR) and overall survival (OS) did not differ in patients with low tumor burden and pathologically confirmed 1-2 positive SLN with or without ALND when breast-conserving surgery and radiation were conducted (1,2,4,12,(18)(19)(20)(21)(22)(23). The OTOASOR trial compares completion of axillary lymph node dissection (ALND) to regional nodal irradiation (RNI) in patients with sentinel lymph node metastasis (pN1 SLN) in stage I-II breast cancer.…”

Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy

“…Relatively conservative mastectomies, such as skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM), have been widely adopted recently with increasing interest in improved cosmetic outcomes and immediate breast reconstruction [ 1 , 2 ]. With regard to postmastectomy radiation therapy (PMRT), the indications for PMRT were revisited through recent guidelines and studies, including patients with intermediate-risk factors [ [3] , [4] , [5] , [6] , [7] ]. Therefore, adjuvant radiation therapy (RT) following reconstruction has become a common practice [ 8 ].…”