Biological Subtype Predicts Locoregional Recurrence After Postmastectomy Radiotherapy in Chinese Breast Cancer Patients

Overview

Journal Cancer Med

Specialty Oncology

Date 2020 Feb 13

PMID 32048817

Citations 7

Authors

Jiangfeng Wang

Jurui Luo

Kairui Jin

Xuanyi Wang

Zhaozhi Yang

Jinli Ma

Xin Mei

Xiaofang Wang

Zhirui Zhou

Xiaoli Yu

Xingxing Chen

Xiaomao Guo

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate the impact of biological subtypes in locoregional recurrence in Chinese breast cancer patients receiving postmastectomy radiotherapy (PMRT).

Methods And Materials: About 583 patients who received postmastectomy radiation between 2010 and 2012 were retrospectively analyzed. According to immunohistochemical staining profile, patients were classified into: Luminal A-like, Luminal B-like, HER2-positive, and triple-negative breast cancer (TNBC). Local and regional recurrence (LRR) cumulative incidences were calculated by competing risks methodology and the power of prognostic factors was examined by Gray's test and the test of Fine and Gray.

Results: The median follow-up was 70.9 months. About 34 LRR events occurred. For Luminal A, Luminal B, HER2-positive, and TNBC patients, the 5-year LRR cumulative incidence rates were 1.57%, 4.09%, 10.74%, and 10.28%. Compared with Luminal A, HER2-positive subtype and TNBC had a significant increased risk of LRR (HR was 5.034 and 5.188, respectively). In univariate analysis, predictive factors for higher LRR were HER2-positive subtype (HR = 4.43, P < .05), TNBC (HR = 4.70, P < .05), and pN3 (HR = 5.83, P < .05). In the multivariate model, HER2-positive subtype (HR = 5.034, P < .05), TNBC (HR = 5.188, P < .05), and pN3 (HR = 9.607, P < .01) were independent predictors of LRR. LRR without trastuzumab was similar to that of TNBC (without vs TNBC, 17.88% vs 10.28%, P > .05) in HER2-positive subtype patients, while LRR with trastuzumab was approximate to Luminal A (with vs Luminal A, P > .05). Additionally, endocrine therapy also significantly reduced LRR incidence in the luminal subtype cohort (without vs with therapy, 6.25% vs 2.89%, HR = 0.365, P < .1).

Conclusions: Biological subtype was a prognostic factor of LRR in the PMRT setting among Chinese breast cancer patients.

Citing Articles

The prognostic analysis of further axillary dissection in breast cancer with 1-2 positive sentinel lymph nodes undergoing mastectomy.

Zhao X, Yang L, Cao C, Song Z Front Oncol. 2024; 14:1406981.

PMID: 39161383 PMC: 11330764. DOI: 10.3389/fonc.2024.1406981.

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study.

Hung S, Yang H, Lee M, Liu D, Chen L, Chew C Breast Cancer Res. 2023; 25(1):149.

PMID: 38066611 PMC: 10709935. DOI: 10.1186/s13058-023-01747-9.

Long-term outcomes of non-metastatic breast cancer patients by molecular subtypes.

Fendereski A, Hajizadeh E, Haghighat S, Rasekhi A BMC Womens Health. 2022; 22(1):268.

PMID: 35787692 PMC: 9254545. DOI: 10.1186/s12905-022-01846-3.

Real-World Practice of Hypofractionated Radiotherapy in Patients With Invasive Breast Cancer.

Chen F, Hui T, Ma L, Nong Y, Han Y, Jing H Front Oncol. 2022; 12:811794.

PMID: 35186748 PMC: 8852155. DOI: 10.3389/fonc.2022.811794.

Intraoperative radiotherapy versus whole-breast external beam radiotherapy, and other factors associated with the prognosis of early breast cancer treated with breast-conserving surgery and radiotherapy: a retrospective study from SEER database.

Sun M, Liu H, Liu Y, Xu L, Ye J Transl Cancer Res. 2022; 9(11):7125-7139.

PMID: 35117317 PMC: 8798017. DOI: 10.21037/tcr-20-2441.

References

Yin W, Lu J, Di G, Lin Y, Zhou L, Liu G . Clinicopathological features of the triple-negative tumors in Chinese breast cancer patients. Breast Cancer Res Treat. 2008; 115(2):325-33. DOI: 10.1007/s10549-008-0096-0. View

Schmid P, Adams S, Rugo H, Schneeweiss A, Barrios C, Iwata H . Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2018; 379(22):2108-2121. DOI: 10.1056/NEJMoa1809615. View

Kyndi M, Sorensen F, Knudsen H, Overgaard M, Nielsen H, Overgaard J . Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol. 2008; 26(9):1419-26. DOI: 10.1200/JCO.2007.14.5565. View

Goldhirsch A, Winer E, Coates A, Gelber R, Piccart-Gebhart M, Thurlimann B . Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013; 24(9):2206-23. PMC: 3755334. DOI: 10.1093/annonc/mdt303. View

Giuliano A, Connolly J, Edge S, Mittendorf E, Rugo H, Solin L . Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67(4):290-303. DOI: 10.3322/caac.21393. View

Lowery A, Kell M, Glynn R, Kerin M, Sweeney K . Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2011; 133(3):831-41. DOI: 10.1007/s10549-011-1891-6. View

Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V . Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366(9503):2087-106. DOI: 10.1016/S0140-6736(05)67887-7. View

Moran M . Radiation therapy in the locoregional treatment of triple-negative breast cancer. Lancet Oncol. 2015; 16(3):e113-22. DOI: 10.1016/S1470-2045(14)71104-0. View

Wang J, Luo J, Jin K, Wang X, Yang Z, Ma J . Biological subtype predicts locoregional recurrence after postmastectomy radiotherapy in Chinese breast cancer patients. Cancer Med. 2020; 9(7):2427-2434. PMC: 7131860. DOI: 10.1002/cam4.2904. View

10.

Torres-Roca J, Fulp W, Caudell J, Servant N, Bollet M, Van de Vijver M . Integration of a Radiosensitivity Molecular Signature Into the Assessment of Local Recurrence Risk in Breast Cancer. Int J Radiat Oncol Biol Phys. 2015; 93(3):631-8. PMC: 5811194. DOI: 10.1016/j.ijrobp.2015.06.021. View

11.

Romond E, Perez E, Bryant J, Suman V, Geyer Jr C, Davidson N . Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005; 353(16):1673-84. DOI: 10.1056/NEJMoa052122. View

12.

Wang S, Li Y, Song Y, Wang W, Jin J, Liu Y . Triple-negative or HER2-positive status predicts higher rates of locoregional recurrence in node-positive breast cancer patients after mastectomy. Int J Radiat Oncol Biol Phys. 2010; 80(4):1095-101. DOI: 10.1016/j.ijrobp.2010.03.038. View

13.

Gee H, Buffa F, Harris A, Toohey J, Carroll S, Cooper C . MicroRNA-Related DNA Repair/Cell-Cycle Genes Independently Associated With Relapse After Radiation Therapy for Early Breast Cancer. Int J Radiat Oncol Biol Phys. 2015; 93(5):1104-14. DOI: 10.1016/j.ijrobp.2015.08.046. View

14.

Smith I, Procter M, Gelber R, Guillaume S, Feyereislova A, Dowsett M . 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet. 2007; 369(9555):29-36. DOI: 10.1016/S0140-6736(07)60028-2. View

15.

Nielsen T, Hsu F, Jensen K, Cheang M, Karaca G, Hu Z . Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004; 10(16):5367-74. DOI: 10.1158/1078-0432.CCR-04-0220. View

16.

Ragaz J, Olivotto I, Spinelli J, Phillips N, Jackson S, Wilson K . Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005; 97(2):116-26. DOI: 10.1093/jnci/djh297. View

17.

Dent R, Trudeau M, Pritchard K, Hanna W, Kahn H, Sawka C . Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13(15 Pt 1):4429-34. DOI: 10.1158/1078-0432.CCR-06-3045. View

18.

Katz S, Morrow M . Addressing overtreatment in breast cancer: The doctors' dilemma. Cancer. 2013; 119(20):3584-8. DOI: 10.1002/cncr.28260. View

19.

Nemeth B, Varga Z, Wu W, Pacher P . Trastuzumab cardiotoxicity: from clinical trials to experimental studies. Br J Pharmacol. 2016; 174(21):3727-3748. PMC: 5647179. DOI: 10.1111/bph.13643. View

20.

Kim H . Cumulative incidence in competing risks data and competing risks regression analysis. Clin Cancer Res. 2007; 13(2 Pt 1):559-65. DOI: 10.1158/1078-0432.CCR-06-1210. View