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Do we need reshape rTNM staging system for ipsilateral breast tumor recurrence of breast cancer? A population-based, propensity score matched cohort study

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Abstract

Background

The aim of the study was to explore the role of recurrent TNM (rTNM) staging in predicting prognosis for ipsilateral breast tumor recurrence (IBTR) and determine the optimal treatment strategy for IBTR.

Method

IBTR cases were identified from the Surveillance, Epidemiology, and End Results (SEER) database spanning the years 2000–2018. Cox proportional hazards analysis was performed to examine factors associated with overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) was employed to match IBTR with primary early breast cancer (EBC) based on clinicopathological characteristics. Investigations into the impact of different therapies were also included.

Results

Of the 4375 IBTR cases included in the study, the 5-year OS was 87.1%, 71.6% and 58.7% in rTNM stages I, II and III, respectively. After PSM, while IBTR patients had worse survival to primary EBC patients, prognosis of IBTR for different rTNM stage always closely aligned with the corresponding stage of primary EBC. Repeat breast-conserving surgery (BCS) with radiation therapy was equivalent to mastectomy with respect to OS and BCSS. Chemotherapy was favorable for OS and BCSS in estrogen receptor (ER)-negative IBTR or IBTR occurring within a 60-month interval.

Conclusions

rTNM staging system has an outstanding prognostic value for survival outcome of patients with IBTR, and IBTR and primary EBC may have potentially analogous features in the context of TNM staging. BCS plus radiation therapy may be an alternative. IBTR cases who have experienced recurrence with short intervals and with ER-negative tumors might benefit from chemotherapy.

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Data availability

The data that support the findings of this study are available from the SEER program (https://seer.cancer.gov/).

Abbreviations

BCS:

Breast-conserving surgery

BCSS:

Breast cancer-specific survival

CT:

Chemotherapy

ER:

Estrogen receptor

HER2:

Human epidermal growth factor 2

IBTR:

Ipsilateral breast tumor recurrence

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

NOS:

Not otherwise specified

OS:

Overall survival

PSM:

Propensity score matching

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Breast Center, Peking University People’s Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China

    Shuwei Zhang, Houpu Yang, Yaqian Xu & Shu Wang

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  1. Shuwei Zhang
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  2. Houpu Yang
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Contributions

SW conceived of the study. SWZ and HPY collected and analyzed the data. SWZ wrote the paper. HPY, YQX and SW was responsible for final editing and approval of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shu Wang.

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This study is conducted using publicly available database and no ethical approval is required.

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Zhang, S., Yang, H., Xu, Y. et al. Do we need reshape rTNM staging system for ipsilateral breast tumor recurrence of breast cancer? A population-based, propensity score matched cohort study. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07340-8

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