Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy

Jianyang Wang,Bin Chen ,Xueying Zhao ,Yu Tang,Yuan Tang,Shulian Wang,Yang Song ,Shunan Qi,Yexiong Li,Siye Chen,Hua Ren,Jianghu Zhang,Ningning Liu ,Yong Yang,Jing Jin,Yueping Liu,Guang-Yi Sun ,Hao Jing,Ning Li,Hui Fang

doi:10.1186/s13014-020-01637-w

Abstract

BackgroundTo analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy.MethodsThe retrospective study included 7073 women with breast cancer without post-mastectomy radiotherapy: 4604 (65.1%) had pT1–2 N0 disease (low risk); 2042 (28.9%), pT1–2 N1 (intermediate risk); and 427 (6.0%), pT3–4 and/or pN2–3, or pT1–2 N1 after neoadjuvant chemotherapy (high risk). The distribution of cumulative locoregional recurrence was analyzed. The local recurrence and regional recurrence rates were estimated by the Kaplan-Meier method, and differences were compared with the log-rank test. Multivariate analysis was performed using Cox logistic regression analysis.ResultsIn the median follow-up of 63.0 months, 469 patients had locoregional recurrence: chest wall recurrence in 238 (50.7%) cases, supraclavicular/infraclavicular nodes in 236 (50.3%) cases, axilla in 92 (19.6%), and internal mammary nodes in 50 (10.7%) cases. The 5-year local recurrence and regional recurrence rates were 2.5 and 4.4%, respectively. Subgroup analysis of the three risk groups and five molecular subtypes (luminal A, luminal B-Her2 negative, luminal B-Her2 positive, Her2-enriched, and triple negative) also showed that the chest wall and supraclavicular/infraclavicular nodes were the most common recurrence sites. Age, tumor location, T stage, N stage, and hormone receptor status were independent prognostic factors for both local recurrence and regional recurrence (p < 0.05).ConclusionsThe chest wall and supraclavicular/infraclavicular nodes are common sites of locoregional recurrence in breast cancer, irrespective of disease stage or molecular subtype, and the prognostic factors for local recurrence and regional recurrence are similar. Therefore, chest wall and supraclavicular/infraclavicular nodes irradiation should always be considered in post-mastectomy radiotherapy.

Highlights

To analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy
Postmastectomy radiotherapy (PMRT) is an important strategy for the locoregional management of breast cancer, as it can reduce the risk of locoregional recurrence (LRR) and decrease breast cancer mortality [1]
We seek to fill in all these information gaps by analyzing the patterns of LRR in a large series of patients with breast cancer who underwent mastectomy along with modern treatment regimens, and by investigating whether locoregional failure was related to disease stage or molecular subtypes

Summary

Introduction

To analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy. Previous randomized studies have shown that chest wall and comprehensive regional nodal irradiation result in a decrease in LRR and an improvement in overall survival in patients with node-positive or T3–4 disease [2–4]. Some studies have shown that the risk of regional nodal recurrence in patients with 1–3 positive nodes is relatively low [5–9], but it is unclear whether comprehensive locoregional radiotherapy is essential for improving survival, or whether delivering radiation to a more limited target volume may achieve a comparable outcome. We seek to fill in all these information gaps by analyzing the patterns of LRR in a large series of patients with breast cancer who underwent mastectomy along with modern treatment regimens, and by investigating whether locoregional failure was related to disease stage or molecular subtypes

Methods

Results

Discussion

Conclusion