Abstract
Background and ObjectivesTo establish a prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive lymph nodes to determine which patients can benefit from postmastectomy radiotherapy (PMRT).MethodsA population-based study was conducted utilizing data collected from the Surveillance, Epidemiology, and End Results database. Chi-square test or Fisher exact test was used to compare the distribution of characteristics. Cox analysis identified significant prognostic factors for survival. A prognostic stratification model was constructed by R software. Propensity score matching was applied to balance characteristics between PMRT cohort and control cohort. Kaplan-Meier method was performed to evaluate the performance of stratification and the benefits of PMRT in the total population and three risk groups.ResultsThe overall performance of the nomogram was good (3-year, 5-year, 10-year AUC were 0.75, 0.72 and 0.67, respectively). The nomogram was performed to excellently distinguish low-risk, moderate-risk, and high-risk groups with 10-year overall survival (OS) of 86.9%, 73.7%, and 62.7%, respectively (P<0.001). In the high-risk group, PMRT can significantly better OS with 10-year all-cause mortality reduced by 6.7% (P = 0.027). However, there was no significant survival difference between PMRT cohort and control cohort in low-risk (P=0.49) and moderate-risk groups (P = 0.35).ConclusionThe current study developed the first prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive axillary lymph nodes and found that patients in the high-risk group may be easier to benefit from PMRT.
Highlights
Breast cancer is the most common malignancy, and its mortality rate ranks second among all cancer-related deaths in females [1]
6690 (36.0%) patients received Postmastectomy radiotherapy (PMRT) were involved in the PMRT cohort, and 11917 (64.0%) patients did not receive PMRT were involved in the control cohort to construct a nomogram
The median follow-ups for the PMRT cohort and control cohort were 63 months (IQR, 40–93 months) and 73 months (IQR, 44–103 months), respectively. 805 (12.0%) people died in the PMRT cohort, while 1635 (13.7%) people died in the control cohort
Summary
Breast cancer is the most common malignancy, and its mortality rate ranks second among all cancer-related deaths in females [1]. PMRT has become an essential therapy for patients of breast cancer with at least four positive lymph nodes. Several retrospective analyses found that PMRT did not decrease the recurrence rate or prolong OS among T1–2 breast cancer with 1–3 positive axillary lymph nodes [7,8,9]. The long-term side effects caused by radiotherapies, such as cardiovascular system damage, secondary cancer, and arm lymphedema, could not be ignored [10] These researchers considered that for patients with 1–3 positive axillary lymph nodes, the strong recommendation of PMRT might be unreasonable. To establish a prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive lymph nodes to determine which patients can benefit from postmastectomy radiotherapy (PMRT)
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