Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

Lin, Po-Han; Yeh, Ming Hsin; Liu, Liang‐Chih; Chen, Chih‐Jung; Tsui, Yu Chu; Su, Chunxia; Wang, Hwei Chung; Liang, Ji An; Chang, Hui; Wu, Hsiao Su; Yeh, Su Peng; Li, Long-yuan; Chiu, Chang Fang

doi:10.1002/jso.23403

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…In node-negative patients, several studies showed LVI was prognostically important because patients with positive LVI had a higher rate of distant metastases and higher local recurrence rate after breast conservation therapy [3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

et al. 2015

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• Tumour ADC was significantly lower in LVI-positive than LVI-negative breast cancer. • Peritumoral maximum-ADC was significantly higher in LVI-positive than LVI-negative breast cancer. • Peritumour-tumour ADC ratio was significantly higher in LVI-positive breast cancer. • Diagnostic performance of the peritumour-tumour ADC ratio was highest for positive LVI. • Peritumour-tumour ADC ratio showed higher diagnostic ability in postmenopausal than premenopausal patients.

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Section: Introductionmentioning

confidence: 99%

Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

et al. 2015

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“…15,23–27 When LVI was absent, the risk of any nodal involvement was 0.28 (95% CI, 0.26–0.31) compared to when it was present. Additionally, LVI is well documented to be a risk factor for local recurrence after both BCT and mastectomy 28–30 , raising the possibility that an increased frequency of LVI could be responsible for the higher rates of local recurrence in the breast and chest wall seen with TN breast cancer. However, we found that of all the subtypes, TN cancers were least likely to have LVI.…”

Section: Discussionmentioning

confidence: 99%

Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

et al. 2014

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Background The ACOSOG Z0011 trial demonstrated that axillary dissection (ALND) is not necessary for local control or survival in women with T1/2cN0 cancer undergoing breast-conserving therapy. There is concern about applying these results to triple-negative (TN) cancers secondary to their high local-recurrence (LR) rate. We examined the frequency of lymphovascular invasion (LVI) and nodal metastases in TN cancers to determine whether ALND can be safely avoided in this subtype. Methods Data were obtained from a database of patients with invasive breast cancer treated at Memorial Sloan Kettering from 1/98–12/10. 11,596 tumors were classifiable into clinical surrogates for molecular subtype by immunohistochemical analysis: hormone receptor (HR)+/HER2+, HR+/HER2-, HR-/HER2+, and TN(HR-/HER2-). Multivariable logistic regression analysis (MVA)was used to determine associations between clinicopathologic variables and subtype. Results There were differences in age, tumor size, LVI, grade, and nodal involvement among groups. On MVA controlling for size, grade, and age, ER, PR, and HER2 status were significantly associated with LVI(p<.0001). Relative to TN tumors, HR+/HER2-, HR+/HER2+, and HR-/HER2+ tumors had higher odds of demonstrating LVI of 1.8(OR,1.8; 95% CI,1.6–2.1), 2.5(2.5;2.0–3.0), and 1.7(1.7;1.4–2.1), respectively. On MVA adjusting for size, grade, LVI, and age, TN tumors had the lowest odds of having any or high-volume nodal involvement (≥4 nodes, p<.0001). Conclusions LVI and nodal metastases were least frequent in TN cancers compared with other subtypes, despite the uniformly worse prognosis and increased LR rate in TN tumors. This suggests TN cancers spread via lymphatics less frequently than other subtypes and ALND may be avoided in TN patients meeting Z0011 eligibility criteria.

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“…Yet, a small proportion of patients fail locoregionally in the modern treatment system. A few trials have demonstrated that subgroups of pT1-2N0 patients with multiple adverse risk factors were at higher risk of LRR [ 9 , 11 , 12 , 18 – 21 ]. Although the risk factors which were associated with LRR have varied among different studies and time eras, the proportion of patients at high risk of LRR was usually around 5–15%.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification for prediction of locoregional recurrence in patients with pathologic T1–2N0 breast cancer after mastectomy

et al. 2020

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Background Previous studies have revealed that nearly 15–20% of selected high-risk T1–2N0 breast cancers developed LRR after mastectomy. This study is aim to indentify the risk factors of locoregional recurrence (LRR) in patients with pathologic T1–2N0 breast cancer after mastectomy in a real-world and distinguish individuals who warrant postmastectomy radiotherapy (PMRT). Methods Female patients treated from 1999 to 2014 in National Cancer Center of China were retrospectively reviewed. A competing risk model was developed to estimate the cumulative incidence of LRR with death treated as a competing event. Results A total of 4841 patients were eligible. All underwent mastectomy plus axillary nodes dissection or sentinel node biopsy without PMRT. With a median follow-up of 56.4 months (range, 1–222 months), the 5-year LRR rate was 3.9%.Besides treatment era, age ≤ 40 years old (p < 0.001, hazard ratio [HR] = 2.262), tumor located in inner quadrant (p < 0.001, HR = 2.236), T2 stage (p = 0.020, HR = 1.419), and negative expressions of estrogen receptor (ER) and progesterone receptor (PR) (p = 0.032, HR = 1.485), were patients-related independent risk factors for LRR. The 5-year LRR rates were 1.7, 3.5, and 15.0% for patients with zero, 1–2, and 3–4 risk factors (p < 0.001). Conclusions Risk Stratification based on age, T stage, ER/PR status and tumor location can stratify patients with pT1–2 N0 breast cancer into subgroups with different risk of LRR. PMRT might be suggested for patients with 3–4 risk factors.

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Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

Abstract: LVI and Nottingham grade 3 were the independent risk factors predicting tumor recurrence for patients with NNBC. Adjuvant radiotherapy might be considered in NNBC patients with these unfavorable factors to improve the RFS.

Cited by 13 publications

References 24 publications

Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

Risk stratification for prediction of locoregional recurrence in patients with pathologic T1–2N0 breast cancer after mastectomy

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