Dan-Qiong Wang, Zhou Huang, Hong-Fen Wu, Dong-Xing Shen, Hao Jing, Hui Fang, Li Zhu, Xiao-Bo Huang, Liang-Fang Shen, Mei Shi, Jia-Yi Chen, Min Liu, Jing Cheng, Ye-Xiong Li, Jian Tie, Yu Tang, Shu-Lian Wang
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Moreover, the locoregional control (LRC), DFS, and overall survival (OS) rates in PMRT and non-PMRT patients were calculated using the Kaplan-Meier method.</p><p><strong>Results: </strong>All patients received a median of four NAC cycles, followed by mastectomy and axillary lymph node dissection; moreover, 257 (41.2%) patients underwent PMRT. Over a median follow-up duration of 74 months, the 5-year LRC, DFS, and OS rates for all patients were 96.6%, 90.1%, and 95.7%, respectively. The differences in the LRC, DFS, and OS rates between PMRT and non-PMRT patients were nonsignificant in the univariate and multivariate analyses. By using our recurrence risk score model based on four factors (i.e., age, clinical N stage, NAC cycle number, and pathological tumor stage after NAC), we stratified the patients into low- and high-risk groups; their 5-year rates of LRC (98.8% vs 93.9%), DFS (95.1% vs 83.8%), and OS (98.4% vs 92.4%) were significantly different (all p < 0.05). PMRT improved LRC (97.6% vs 90.8%, p = 0.027) but not DFS or OS in high-risk patients and had no benefit in low-risk patients.</p><p><strong>Conclusion: </strong>Our recurrence risk score model effectively distinguished ypN0 patients with different recurrence risk stratifications. 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Moreover, the locoregional control (LRC), DFS, and overall survival (OS) rates in PMRT and non-PMRT patients were calculated using the Kaplan-Meier method.</p><p><strong>Results: </strong>All patients received a median of four NAC cycles, followed by mastectomy and axillary lymph node dissection; moreover, 257 (41.2%) patients underwent PMRT. Over a median follow-up duration of 74 months, the 5-year LRC, DFS, and OS rates for all patients were 96.6%, 90.1%, and 95.7%, respectively. The differences in the LRC, DFS, and OS rates between PMRT and non-PMRT patients were nonsignificant in the univariate and multivariate analyses. By using our recurrence risk score model based on four factors (i.e., age, clinical N stage, NAC cycle number, and pathological tumor stage after NAC), we stratified the patients into low- and high-risk groups; their 5-year rates of LRC (98.8% vs 93.9%), DFS (95.1% vs 83.8%), and OS (98.4% vs 92.4%) were significantly different (all p < 0.05). 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引用次数: 0
摘要
背景：乳房切除术后放疗（PMRT）在新辅助化疗（NAC）后淋巴结病理阴性（ypN0）的乳腺癌患者中的作用由于异质性复发风险和缺乏前瞻性证据仍然存在争议。目的：评价PMRT对NAC后ypN0患者的疗效。设计：多中心回顾性研究。方法：采用基于无病生存（DFS）率的多因素Cox模型，对624例乳腺癌患者的ypN0数据进行评估，建立复发风险评分模型。此外，使用Kaplan-Meier方法计算PMRT和非PMRT患者的局部区域控制率（LRC）、DFS和总生存率（OS）。结果：所有患者均接受中位数为4个NAC周期，随后行乳房切除术和腋窝淋巴结清扫术；此外，257例（41.2%）患者接受了PMRT。在74个月的中位随访期间，所有患者的5年LRC、DFS和OS率分别为96.6%、90.1%和95.7%。在单因素和多因素分析中，PMRT患者和非PMRT患者的LRC、DFS和OS率差异无统计学意义。采用基于年龄、临床N分期、NAC周期数、NAC后病理肿瘤分期4个因素的复发风险评分模型，将患者分为低危组和高危组；5年LRC （98.8% vs 93.9%）、DFS （95.1% vs 83.8%）、OS （98.4% vs 92.4%）差异有统计学意义（均p）。结论：我们的复发风险评分模型有效区分了不同复发风险分层的ypN0患者。PMRT改善了高风险患者的LRC，但没有改善DFS或OS，低风险患者没有从PMRT中获益。
A recurrence risk score model evaluating effects of postmastectomy radiotherapy in breast cancer patients with pathologically negative lymph nodes after neoadjuvant chemotherapy: a multicenter, retrospective study.
Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients achieving pathologically negative lymph nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains controversial due to heterogeneous recurrence risks and lack of prospective evidence.
Objectives: To evaluate the effects of PMRT in ypN0 patients after NAC.
Design: Multicenter retrospective study.
Methods: Data of 624 breast cancer patients with ypN0 was assessed to establish a recurrence risk score model based on a disease-free survival (DFS) rate-based multivariate Cox model. Moreover, the locoregional control (LRC), DFS, and overall survival (OS) rates in PMRT and non-PMRT patients were calculated using the Kaplan-Meier method.
Results: All patients received a median of four NAC cycles, followed by mastectomy and axillary lymph node dissection; moreover, 257 (41.2%) patients underwent PMRT. Over a median follow-up duration of 74 months, the 5-year LRC, DFS, and OS rates for all patients were 96.6%, 90.1%, and 95.7%, respectively. The differences in the LRC, DFS, and OS rates between PMRT and non-PMRT patients were nonsignificant in the univariate and multivariate analyses. By using our recurrence risk score model based on four factors (i.e., age, clinical N stage, NAC cycle number, and pathological tumor stage after NAC), we stratified the patients into low- and high-risk groups; their 5-year rates of LRC (98.8% vs 93.9%), DFS (95.1% vs 83.8%), and OS (98.4% vs 92.4%) were significantly different (all p < 0.05). PMRT improved LRC (97.6% vs 90.8%, p = 0.027) but not DFS or OS in high-risk patients and had no benefit in low-risk patients.
Conclusion: Our recurrence risk score model effectively distinguished ypN0 patients with different recurrence risk stratifications. PMRT improved LRC but not DFS or OS in high-risk patients and low-risk patients did not benefit from PMRT.
期刊介绍：
Therapeutic Advances in Medical Oncology is an open access, peer-reviewed journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of cancer. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in medical oncology, providing a forum in print and online for publishing the highest quality articles in this area. This journal is a member of the Committee on Publication Ethics (COPE).
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