Are there high-risk subgroups for isolated locoregional failure in patients who had T1/2 breast cancer with one to three positive lymph nodes and received mastectomy without radiotherapy?

Hamamoto, Yasushi; Ohsumi, Shozo; Aogi, Kenjiro; Shinohara, Syuichi; Nakajima, N.; Kataoka, Makoto; Takashima, Shigemitsu

doi:10.1007/s12282-012-0369-7

Cited by 18 publications

(8 citation statements)

References 16 publications

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“…In the adjuvant settings, the LRR rates ranged from 3% to 20% in patients with T1–2 with 1–3 positive axillary lymph nodes (ALN). 13 , 14 Various risk factors such as age, grade, LVI, numbers of positive lymph node, and so on affect LRR. Similar results were also observed in NAC settings from retrospective analyses.…”

Section: Discussionmentioning

confidence: 99%

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Wang¹,

Xu²,

Yin³

et al. 2018

CMAR

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ObjectiveIn order to identify risk factors associated with locoregional recurrence (LRR) and assess the role of postmastectomy radiotherapy (PMRT) in early breast cancer (BC), managed with neoadjuvant chemotherapy (NAC) and mastectomy, a retrospective analysis of BC diagnosed with clinical stage T1-2N0-1 was conducted.Patients and methodsA total of 217 patients were included in this analysis. The median age was 50 years (24–72 years). The clinical stage distributions were cT1 in 15 cases, cT2 in 202, cN0 in 53, and cN1 in 161 cases. All patients were treated with NAC and mastectomy, and 128 patients received PMRT.ResultsWith a median follow-up time of 61 months, the 5-year cumulative LRR rate was 12%. Multivariate analysis demonstrated that pathological N stage, lymph-vascular invasion, and histological grade were independent prognostic factors associated with LRR. A nomogram model based on these factors was established, based on which the patients were deeply stratified into low- and high-risk group. In the low-risk group, radiotherapy did not decrease LRR (3.3% in PMRT group, 1.7% in no PMRT group, P=0.192). While in the high-risk group, PMRT significantly decreased LRR (21.8% in PMRT group, 42.2% in no PMRT group, P=0.031).ConclusionLymph-vascular invasion, histological grade, as well as pathological N stage were important prognostic factors associated with LRR in BC patients staged in cT1-2N0-1, who were managed with NAC and mastectomy. In our cohort, not only clinical and pathological stage information but also other risk factors were taken into consideration when adjuvant PMRT was recommended. In the high-risk subgroup, PMRT significantly improved the prognosis.

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Section: Discussionmentioning

confidence: 99%

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Wang¹,

Xu²,

Yin³

et al. 2018

CMAR

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“…13 , 14 For breast cancer, it is critical for therapeutic decisions, including radiation therapy, chemotherapy, and follow up. 15 , 16 While the number of lymph nodes examined is controversial for patients: inadequate nodal examination may lead to missing nodal invasion, while excessive nodal examination reduces immune activity and has long term complications. 11 Thus, balancing diagnostic accuracy with the drawbacks of lymph node removal is critical for improving survival times and the life quality of breast cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the number of lymph nodes for examination in breast cancer

Sun

Ren

et al. 2019

J Int Med Res

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Objective Examining the correct number of lymph nodes when diagnosing breast cancer invasion is still a problem. This work aimed to develop a qualification model that estimates the possibility of missing nodes and the number of lymph nodes that need to be examined. Methods By analyzing lymph node invasion of 303,760 breast cancer samples with primary tumor stage and the number of examined and positive lymph nodes from the Surveillance, Epidemiology and End Results database using a beta-binomial model, the number of nodes that should be examined was quantified in different stages. Results In general, to reduce the possibility of missing positive nodes to less than 10%, 21 lymph nodes should be examined; thus, the current median of dissected nodes (12) is not adequate. The number of nodes needed to be dissected for stages T1, T2, and T3 are 8, 37, and 87, respectively. Currently, the median number of node dissections for these stages were 12, 13, and 14, respectively. The clinical significance of the nodal staging score was validated with survival information. Conclusion Currently, the number of lymph nodes dissected in breast cancer are excessive for T1 but insufficient for T2 and T3.

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“…Four or more ALNs was the main risk factor, the others were minor risk factors. The 8-year LRFS were 98%, 97%, 86%, 87%, 88%, 72% and 28% for patients with 0, 1, 2, 3–4 minor risk, only the main risk factor, the main risk with 1-2 minor risk factors and the main risk with 3-4 minor risk factors [ 10 ]. Nevertheless, whether T1-2 breast cancer patients with 1 to 3 positive ALNs should receive PMRT or not is still uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Impact of postmastectomy radiation therapy in T1-2 breast cancer patients with 1-3 positive axillary lymph nodes

Yin

Wang

et al. 2017

Oncotarget

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The effect of postmastectomy radiotherapy (PMRT) on T1-2 breast cancer patients with 1-3 positive axillary lymph nodes is controversial up to now. The purpose of this study was to evaluate the impact of postmastectomy radiotherapy for these patients. The prognostic factor effecting locoregional free-survival (LRFS) was also analyzed. In the retrospective clinical data of 1674 eligible patients, survival analysis was performed using the method of Kaplan-Meier and the log-rank test. Cox regression analysis was applied to identify the significant prognostic factors. We found PMRT increased 5-year LRFS (p=0.003), but could not improve 5-year disease-free survival or overall survival statistically. For patients without PMRT, multivariate analysis revealed that age, lymph node ratio and molecule subtype were risk factors effecting LRFS. To further analyze the role of PMRT, we grouped all the patients into low risk group (0 or 1 risk factor) and high risk group (2 or 3 risk factors) depending on these risk factors. We found that in low-risk group, PMRT increased only 5-year LRFS (p=0.012). However, in high-risk group, PMRT increased both 5-year LRFS (p=0.005) and 5-year disease-free survival (p=0.033), but could not improve 5-year overall survival statistically. Thus, these data provide the evidence that PMRT could improve LRFS for T1-2 breast cancer patients with 1-3 positive axillary lymph nodes. Additionally, PMRT could improve LRFS and disease-free survival for high risk patients. Age, lymph node ratio and molecule subtype were high risk factors effecting LRFS in our study.

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Are there high-risk subgroups for isolated locoregional failure in patients who had T1/2 breast cancer with one to three positive lymph nodes and received mastectomy without radiotherapy?

Cited by 18 publications

References 16 publications

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy

Quantifying the number of lymph nodes for examination in breast cancer

Impact of postmastectomy radiation therapy in T1-2 breast cancer patients with 1-3 positive axillary lymph nodes

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