Radiotherapy after surgery has significant survival benefits for patients with triple‐negative breast cancer

Abstract

Objectives The value of adjuvant radiotherapy for triple‐negative breast cancer (TNBC) has been controversial recently. This study aims to clarify the influence of radiotherapy on the survival of TNBC patients after surgery based on a large population analysis. Methods The Surveillance, Epidemiology, and End Results (SEER) database was exploited to select eligible patients from 2010 to 2014. The categorical variables were examined by chi‐square tests. Breast cancer‐specific survival (BCSS) and overall survival (OS) were compared among patients who received or not received adjuvant radiotherapy after surgery by Kaplan‐Meier method with log‐rank test. Univariate and multivariate survival analysis of BCSS and OS were performed using the Cox proportional hazard model. Results Totally 22 802 patients were enrolled in this study, of which 10 905 patients received radiotherapy after surgery while 11 897 patients did not receive radiotherapy. Compared with those patients who did not receive radiotherapy, the radiation group had a larger proportion of tumor size <2.0 cm (45.8% vs 38.8%) and chemotherapy (82.5% vs 67.4%). The Kaplan‐Meier plots displayed that patients in the radiation group had better survival than the no radiation group in both BCSS and OS (P < 0.001, respectively). In univariate Cox analysis of BCSS, age 40‐60, married status, white and other race, chemotherapy, radiation, and surgery were associated with better survival (HR < 1, P < 0.05). Specifically, patients who received radiotherapy exhibited better BCSS (HR = 0.52, 95% CI = 0.48‐0.57, P < 0.001). After adjusting for confounding factors by multivariable Cox regression analysis, receipt of radiotherapy was still associated with improved BCSS (HR = 0.79, 95% CI = 0.72‐0.87, P < 0.001). Survival analysis of OS produced similar results. Generally, these data indicate that radiotherapy after surgery has significant survival benefits for the TNBC patients. Conclusions This study has confirmed the survival advantage of adjuvant radiotherapy for the TNBC patients. These findings may optimize the current individualized treatment decisions for this patient population.

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

“…A report from CCO highlights that in Ontario, the majority of women with BC are receiving surgical treatment within the recommended time from diagnosis, which is 28 days for invasive but not highly aggressive malignancy. 34 The adjuvant treatment rate in our study aligns with similar contemporary cohorts 14,35 and was initiated at a median of 44 days after surgery. However, recent studies [36][37][38] have shown improved outcomes in TNBC patients starting AT within 30 days, highlighting a critical opportunity for improvement.…”

“…This is similar to a Swiss study 13 and significantly higher than other reported rates of around 48%. 7,14,35 This is a positive observation considering the survival benefit of adjuvant RT seen in a Danish study 42 and a more recent confirmative population-based study. 35 The rate of exposure to systemic therapy in our cohort (80% in stage I-III and 73% in stage IV) was similar to or better than many similar populations.…”

“…7,14,35 This is a positive observation considering the survival benefit of adjuvant RT seen in a Danish study 42 and a more recent confirmative population-based study. 35 The rate of exposure to systemic therapy in our cohort (80% in stage I-III and 73% in stage IV) was similar to or better than many similar populations. 3,10,13,14,30 The top regimens observed in our TNBC population were diverse but generally included an anthracycline and/or taxane aligning with the guideline recommendations relevant at the time of our study.…”

Gene Expression Profiles Induced by High-dose Ionizing Radiation in MDA-MB-231 Triple-negative Breast Cancer Cell Line

“…To our knowledge, limited data are reported regarding the IR-induced gene expression changes in relation to BC tumor grading (20)(21)(22)(23)(24). In this sense, we recently reported IRinduced low grade-and high grade-specific signaling in BC cells (5).…”

“…In addition, the absence of hormonal or targeted therapy against TNBC makes it a clinical challenge for oncologists in terms of patient management. However, Yao and colleagues have recently reported a survival advantage of adjuvant RT for TNBC patients, underling the necessity to study and clarify molecular mechanisms active in these cells and how these are involved in regulating cell survival/death balance (24).…”