Abstract
To investigate the temporal trends of postoperative radiotherapy (RT) administration and the effects of omitting postoperative RT on breast cancer-specific survival (BCSS) in women aged ≥65 years with tubular carcinoma (TC) of the breast who received breast-conserving surgery (BCS). We included women aged ≥65 years with non-metastatic TC of the breast who underwent BCS between 2000 and 2013 using the Surveillance, Epidemiology, and End Results database. Statistical analyses were performed using chi-square tests, Kaplan-Meier analyses, Cox proportional hazards models, and a 1:1 propensity score matching (PSM). Before PSM, a total of 1,475 patients with tumor size ≤2 cm, node-negative disease, and estrogen receptor-positive disease were identified, including 927 (62.8%) underwent postoperative RT and 548 (37.2%) had postoperative omission of RT. The administration of postoperative RT steadily declined over the study period. Patients with younger age, larger tumor size, and other race/ethnicity were more likely to receive postoperative RT. The median follow-up duration was 85.0 months, the 5- and 10-year BCSS rates were 98.7 and 97.9%, respectively. The median BCSS was 161.9 and 165.0 months for patients with and without postoperative RT, respectively, and the corresponding 5-year BCSS rates were 98.5 and 98.8%, respectively (p = 0.134). Prognostic analysis indicated that postoperative RT was not associated with improved BCSS rates compared with RT omission (p = 0.134). After PSM, a total of 431 complete pairs were generated. In the matched population, the 5-year BCSS rates were 98.6 and 98.4% in non-postoperative RT and postoperative RT groups, respectively (p = 0.858). The univariate analyses also confirmed that the administration of postoperative RT was not associated with better BCSS (p = 0.858). The incidence of breast cancer-related death is probably sufficiently low to avoid postoperative RT in women aged ≥65 years with TC of the breast after BCS.
Highlights
Tubular carcinoma (TC)—a rare but distinct histological variant of well-differentiated invasive breast cancer—is characterized by the stromal invasion of well-formed tubular or glandular structures, and accounts for 1–2% of invasive breast cancer in the screening programs era [1,2,3]
In patients aged ≥65 years with node-negative and hormone receptorpositive disease who underwent breastconserving surgery (BCS), the omission of postoperative RT may increase the incidence of ipsilateral breast tumor recurrence (1.3 vs. 4.1%); the survival outcomes, including regional recurrence, distant metastases, and overall survival (OS) were comparable [13]
Multivariable logistic regression analysis was performed to assess factors independently related to postoperative RT administration (Table 2), the results indicated that patients with younger age (
Summary
Tubular carcinoma (TC)—a rare but distinct histological variant of well-differentiated invasive breast cancer—is characterized by the stromal invasion of well-formed tubular or glandular structures, and accounts for 1–2% of invasive breast cancer in the screening programs era [1,2,3]. In patients aged ≥65 years with node-negative and hormone receptorpositive disease who underwent BCS, the omission of postoperative RT may increase the incidence of ipsilateral breast tumor recurrence (1.3 vs 4.1%); the survival outcomes, including regional recurrence, distant metastases, and overall survival (OS) were comparable [13]. The effect of histological subtype stratification on survival outcomes remains unclear This is the major unresolved aspect of the management of postoperative RT in elderly patients with TC of the breast after BCS. Inclusion criteria were included: [1] women aged ≥65 years with newly diagnosed non-metastatic TC of the breast; [2] had undergone BCS with or without postoperative beam RT; and [3] with available demographic, clinicopathologic, and treatment data, including age, race/ethnicity, grade, tumor stage, nodal stage, estrogen receptor (ER) status, progesterone receptor (PR) status, and receipt of chemotherapy. All analyses were conducted using version 22 of the SPSS Statistical Software (IBM Corporation, Armonk, NY, USA) and the software STATA (Version 14.0; Stata Corp., College Station, TX, USA), and a p value of
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