Oncotarget

Clinical Research Papers:

The role of postmastectomy radiotherapy in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes after neoadjuvant chemotherapy: an analysis from the NCDB

Jieqiong Liu, Kai Mao, Shuai Jiang, Wen Jiang, Kai Chen, Betty Y.S. Kim, Qiang Liu and Lisa K. Jacobs _

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Oncotarget. 2016; 7:24848-24859. https://doi.org/10.18632/oncotarget.6664

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Abstract

Jieqiong Liu1,2,*, Kai Mao3,4,*, Shuai Jiang5, Wen Jiang6, Kai Chen1,2, Betty Y.S. Kim7, Qiang Liu1 and Lisa K. Jacobs2

1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

3 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of General Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

4 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

6 Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA

7 Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, USA

* These authors have contributed equally to this work

Correspondence to:

Lisa K. Jacobs, email:

Jieqiong Liu, email:

Keywords: breast cancer, postmastectomy radiotherapy, complete pathological nodal response, neoadjuvant chemotherapy, survival benefit

Received: September 10, 2015 Accepted: November 26, 2015 Published: December 18, 2015

Abstract

Purpose: The role of postmastectomy radiotherapy (PMRT) in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains controversial.

Methods: A total of 1560 clinically node-positive, stage II-III breast cancer patients treated with NAC and mastectomy who achieved ypN0 between 1998 and 2009 in the National Cancer Database were analyzed. The effects of PMRT on overall survival (OS) for the entire cohort and multiple subgroups were evaluated. Imputation and propensity score matching were used as sensitivity analyses to minimize biases.

Results: Of the entire 1560 eligible patients, 903 (57.9%) received PMRT and 657 (42.1%) didn’t. At a median follow-up of 56.0 months, no statistical difference was observed for OS between two groups by univariate and multivariate analyses (P = 0.120; HR 1.571, 95% CI 0.839-2.943). On subgroup analyses, PMRT significantly improved OS in patients with clinical stage IIIB/IIIC disease, T3/T4 tumor, or residual invasive breast cancer after NAC (P < 0.05). This improvement in OS remained significant after sensitivity analyses for the propensity score-matched patients.

Conclusions: This study demonstrated that PMRT showed a heterogeneous effect in clinically node-positive, stage II-III breast cancer patients with ypN0 following NAC. PMRT improved OS for patients with clinical stage IIIB/IIIC disease, T3/T4 tumor, or residual invasive breast tumor after NAC. In the absence of definitive conclusions from prospective studies, including the ongoing NSABP B-51 trial, our findings may help identify specific groups of women with clinically node-positive, stage II-III breast cancers who could benefit from PMRT after NAC.


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