Survival benefit of radiotherapy after surgery in de novo stage IV breast cancer: a population-based propensity-score matched analysis

Kim, Yi Jun; Jung, Sung Eun; Kim, Kyubo

doi:10.1038/s41598-019-45016-2

Cited by 21 publications

(24 citation statements)

References 34 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the efficacy of local treatment in these patients showed contradictory results in prospective studies (8)(9)(10)(11), current retrospective studies with large cohorts had suggested that local treatment could improve the survival of this patient subset (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). However, most studies are mainly based on surgical treatment, and there are currently no prospective studies to compare the role of radiotherapy and surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, four recent randomized trials that investigated prognosis after surgery in de novo stage IV breast cancer reported conflicting results (8)(9)(10)(11). Several retrospective studies have shown a survival advantage with locoregional treatment, including surgery or radiotherapy to the primary site (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The rationale for proceeding with additional surgery or radiotherapy includes the possibility of increasing the effectiveness of chemotherapy, reducing the total tumor burden, restoring immunity, eliminating breast cancer stem cells, and decreasing the likelihood of resistant disease, which may lower the metastatic potential of the primary tumor (22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

et al. 2020

View full text Add to dashboard Cite

Introduction To investigate the effect of local treatment strategy on survival outcome in de novo stage IV breast cancer patients who received chemotherapy. Methods We identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan–Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses. Results We identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM. Conclusions Compared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with de novo stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Current discussions as to whether adding radiotherapy to surgery can bring additional effects to surgery alone are an active topic of debate. Only one study has focused on this area: Yi-jun Kim et al evaluated the efficacy of adding radiotherapy to surgery in their study and concluded that combined treatment may increase the survival rate in dnMBC patients when compared with surgery alone ( 19 ). We feel that not considering the status of systemic treatment is a big limitation of their study.…”

Section: Introductionmentioning

confidence: 99%

Impact of Postoperative Radiotherapy on Survival of Patients With de novo Stage IV Breast Cancer: A Population-Based Study From the SEER Database

et al. 2021

View full text Add to dashboard Cite

Purpose: In our study, we aimed to evaluate the role of postoperative radiotherapy for patents with de novo stage IV breast cancer.Patients and Methods: Patients diagnosed with stage IV breast cancer from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Those patients who received both chemotherapy and surgery and lived longer than 6 months were divided into radiotherapy and non-radiotherapy groups. Kaplan-Meier analysis and multivariate Cox proportional hazards models were used to estimate the survival outcomes before and after being 1:1 propensity score matched (PSM). Subgroup analyses stratified by age, subtype, status of distant metastasis, and surgery type were also performed.Results: Among 1,935 patients, 52% (1006) underwent radiotherapy while the non-radiotherapy group contained 48% (929). After PSM, a total of 1,520 patients in two groups of 760 patients were enrolled in this analysis. Kaplan-Meier and the multivariate survival analysis demonstrated that the radiotherapy group presented with a better prognosis compared to the non-radiotherapy group (after PSM, BCSS: Hazard Ratio, 0.697; 95% confidence interval, 0.59–0.823; P < 0.001; OS: Hazard Ratio, 0.707; 95% confidence interval, 0.601–0.831; P < 0.001). Further subgroup analyses showed the Luminal subtype (HR+/HER2–), triple-negative breast cancer (TNBC), and bone-only metastasis patients presented with the most promising survival in the radiotherapy group.Conclusions: Postoperative radiotherapy is associated with a significant survival advantages in BCSS and OS. It can be an optimal supplementary treatment for stage IV patients after surgery, especially for Luminal subtype, TNBC, and patients with a low metastatic burden.

show abstract

“…In the past decades, advances in molecular biology have contributed to significant improvements in the diagnosis and classification of breast cancer ( 2 , 3 ). Surgery, radiotherapy and chemotherapy (hormone and targeted) have shown remarkable survival benefits in patients with breast cancer ( 4 ). Approximately 30% of breast tumors overexpress human epidermal growth factor receptor 2 (HER-2) ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

miR‑135b‑5p enhances the sensitivity of HER‑2 positive breast cancer to trastuzumab via binding to cyclin�D2

Qin

Chen

et al. 2020

Int J Mol Med

View full text Add to dashboard Cite

Trastuzumab has led to a marked improvement in the outcomes of patients with human epidermal growth factor receptor 2 (HER-2)-positive breast cancer. However, the effects of trastuzumab on HER-2-positive breast cancer are limited by the emergence of its cardiotoxicside effects. MicroRNA (miR)-135b-5p has been shown to inhibit tumor metastasis in breast cancer. The present study aimed to explore the effects of miR-135b-5p overexpression on the efficacy of trastuzumab in HER-2-positive breast cancer. Reverse transcription-quantitative PcR was performed to detect the levels of miR-135b-5p. cell viability was evaluated with a cell counting Kit-8 assay. Annexin V/propidium iodide staining was employed to detect the number of apoptotic cells. Flow cytometry assay was performed to investigate the cell cycle. Western blotting was used to detect the expression levels of Bax, cleaved caspase-3, Bcl-2, cyclin d2, p27 Kip1 and cyclin E1. cell migration and invasion were detected by Transwell assay. Luciferase assays were conducted to identify the target gene of miR-135b-5p. In addition, an in vivo tumor xenograft model was established. miR-135b-5p agomir significantly enhanced the anti-proliferative effect of trastuzumab on HER-2-positive breast cancer cells via the induction of apoptosis, whereas the anti-metastatic effect of trastuzumab was enhanced by miR-135b-5p agomir treatment. Subsequently, luciferase assays indicated that cyclin d2 was the direct target of miR-135b-5p, whereas overexpression of the latter arrested cell cycleduring the G 0 /G 1 phase. Moreover, miR-135b-5p agomir notably increased the antitumor effect of trastuzumab in vivo. The data demonstrated that miR-135b-5p sensitized HER-2-positive breast cancer cells to trastuzumab in vitro and in vivo by directly binding to cyclin d2. These results suggested that the combination of miR-135b-5p with trastuzumab may be a therapeutic strategy for patients with HER-2-positive breast cancer.

show abstract

Survival benefit of radiotherapy after surgery in de novo stage IV breast cancer: a population-based propensity-score matched analysis

Cited by 21 publications

References 34 publications

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

Impact of Postoperative Radiotherapy on Survival of Patients With de novo Stage IV Breast Cancer: A Population-Based Study From the SEER Database

miR‑135b‑5p enhances the sensitivity of HER‑2 positive breast cancer to trastuzumab via binding to cyclin�D2

Contact Info

Product

Resources

About