Lymphovascular invasion as a negative prognostic factor for triple-negative breast cancer after surgery

Ahn, Ki Jung; Park, Ji Sun; Choi, Yun seon

doi:10.3857/roj.2017.00416

Cited by 23 publications

(20 citation statements)

References 25 publications

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“…However, in the high-risk subgroup with LVI and HG 3, which were identified as independent factors associated with poor DFS, the BCS+RT group showed significantly better RFFS than the MRM-alone group. This implied that there might be a role of adjuvant RT in reducing regional recurrence for patients with LVI and HG 3, which are well-known risk factors related to poor locoregional control and LN metastasis [20,26-28]. Therefore, PMRT is a consideration for patients with LVI and HG III even in the modern chemotherapy era.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Yoo

Park

et al. 2019

Cancer Res Treat

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Purpose We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy. Materials and Methods We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups. Results The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly. Conclusion There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

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Section: Discussionmentioning

confidence: 99%

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Yoo

Park

et al. 2019

Cancer Res Treat

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“…While breast conservation therapy has been established as the appropriate local therapy for most of early stage breast cancer [ 15 , 16 ], mastectomy is still performed in a significant number of patients. Moreover, considering a higher rate of locoregional recurrence in TNBC, the optimal local therapy for these patients has been under debate [ 2 - 5 ]. Regarding this issue, a meta-analysis by Wang et al demonstrated that BCS+RT was less likely to develop locoregional recurrence compared with mastectomy, but comparisons according to specific stage were not performed [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Triple-negative breast cancer (TNBC) has the higher risk for locoregional recurrence than any other molecular subtypes in the absence of effective targeted agents which are known to further decrease locoregional recurrence [ 1 ]. Therefore, there have been concerns on the potentially increased risk of locoregional recurrence after breast conservation therapy in TNBC [ 2 - 5 ]. Although a meta-analysis demonstrated the improved locoregional control by breast conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy alone in TNBC [ 6 ], stage-specific comparisons were not performed in this meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23

et al. 2018

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PurposeThe aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC).Materials and MethodsUsing two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) receivedwhole breast RTwith orwithoutregional nodal RT,while nonewho underwent mastectomy (n=108)received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group.ResultsThe median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio ≥ 0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregionalrecurrence-free, disease-free, and overall survivalrates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively).ConclusionIn pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

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“…L YMPHOVASCULAR INVASION (LVI), defined as the infiltration of tumor cells into lymphatic or blood vessels at the periphery of the invasive carcinoma, 1 has been widely recognized as a negative prognostic factor in invasive breast cancer. [2][3][4][5][6] Studies have revealed that LVI status facilitates the selection of an optimal therapeutic strategy for individual breast cancer patients. [7][8][9][10][11] The extent of LVI is an important factor for predicting neoadjuvant chemotherapy (NAC) efficacy.…”

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confidence: 99%

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Liu

Bao

et al. 2019

Magnetic Resonance Imaging

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Background Lymphovascular invasion (LVI) status facilitates the selection of optimal therapeutic strategy for breast cancer patients, but in clinical practice LVI status is determined in pathological specimens after resection. Purpose To explore the use of dynamic contrast‐enhanced (DCE)‐magnetic resonance imaging (MRI)‐based radiomics for preoperative prediction of LVI in invasive breast cancer. Study Type Prospective. Population Ninety training cohort patients (22 LVI‐positive and 68 LVI‐negative) and 59 validation cohort patients (22 LVI‐positive and 37 LVI‐negative) were enrolled. Field Strength/Sequence 1.5 T and 3.0 T, T1‐weighted DCE‐MRI. Assessment Axillary lymph node (ALN) status for each patient was evaluated based on MR images (defined as MRI ALN status), and DCE semiquantitative parameters of lesions were calculated. Radiomic features were extracted from the first postcontrast DCE‐MRI. A radiomics signature was constructed in the training cohort with 10‐fold cross‐validation. The independent risk factors for LVI were identified and prediction models for LVI were developed. Their prediction performances and clinical usefulness were evaluated in the validation cohort. Statistical Tests Mann–Whitney U‐test, chi‐square test, kappa statistics, least absolute shrinkage and selection operator (LASSO) regression, logistic regression, receiver operating characteristic (ROC) analysis, DeLong test, and decision curve analysis (DCA). Results Two radiomic features were selected to construct the radiomics signature. MRI ALN status (odds ratio, 10.452; P < 0.001) and the radiomics signature (odds ratio, 2.895; P = 0.031) were identified as independent risk factors for LVI. The value of the area under the curve (AUC) for a model combining both (0.763) was higher than that for MRI ALN status alone (0.665; P = 0.029) and similar to that for the radiomics signature (0.752; P = 0.857). DCA showed that the combined model added more net benefit than either feature alone. Data Conclusion The DCE‐MRI‐based radiomics signature in combination with MRI ALN status was effective in predicting the LVI status of patients with invasive breast cancer before surgery. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:847–857.

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Lymphovascular invasion as a negative prognostic factor for triple-negative breast cancer after surgery

Cited by 23 publications

References 25 publications

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

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