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Postmastectomy radiotherapy in patients with T1-2N1 breast cancer: a single center experience and a meta-analysis

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Abstract

Purpose

Postmastectomy radiotherapy (PMRT) in patients with T1–2N1 breast cancer is still controversial. This study was to evaluate the survival prognosis of T1-2N1 patients with or without PMRT.

Patients and methods

From January 2006 to May 2017, 2606 female breast cancer patients underwent mastectomy in our medical center, among whom 402 patients of T1-2N1 stage with or without PMRT were finally analyzed. The median follow-up duration was 59.5 months. The primary endpoint was overall survival (OS). The secondary endpoint was disease-free survival (DFS).

Results

In the study of our center, no statistically significant difference was observed between the T1-2N1 PMRT and non-PMRT subgroups for the 5-year OS (94.4% vs 95.4%, p = 0.667) and DFS (90.1% vs. 91.1%, p = 0.798). By the date of the last follow-up, 8.96% (n = 36) of the patients experienced any recurrence. Univariate analysis revealed that PMRT was not a prognostic factor for either OS (p = 0.667) or DFS (p = 0.798) in T1-2N1 patients. We then did a meta-analysis on the current treatment patterns, in which 2606 PMRT and 4281 non-PMRT T1-2N1 breast cancer patients with mastectomy were included. The meta-analysis showed that PMRT didn't improve the OS of the patients (HR = 0.85, p = 0.11), but patients with PMRT had better DFS than those in the non-PMRT group (HR = 0.62, p < 0.001).

Conclusion

PMRT did not affect the survival of T1-2N1 breast cancer patients who underwent mastectomy, suggesting that radiotherapy may be safely omitted for them.

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Data availability

In this study, all the patients’ data were from the Second Affiliated Hospital, Zhejiang University School of Medicine, which are not publicly available to protect patient privacy but can be accessed from the corresponding author, Dr. Jiaojiao Zhou (zhoujj@zju.edu.cn), on reasonable request.

Abbreviations

PMRT:

Postmastectomy radiotherapy

DFS:

Disease-free survival

OS:

Overall survival

LRR:

Local recurrence rate

LR:

Locoregional recurrence

DM:

Distant metastasis

HER2:

Human epidermal receptor 2

TNBC:

Triple negative breast cancer

SLNB:

Sentinel lymph node biopsy

ALND:

Axillary lymph node dissection

HR:

Hazard ratio

PFS:

Progression-free survival

LRFS:

Locoregional free-survival

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Acknowledgements

We gratefully thank Professor Qichun Wei from Department of Radiation Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, for his valuable advice in radiation therapy related data analysis.

Funding

This study was supported by grants from the Natural Science Foundation of Zhejiang Province (Grant No. LY21H160039 to JJ Zhou), the National Natural Science Foundation of China (Grant No. 82172344 to JJ Zhou), the funding of Medical Science and Technology Project of Zhejiang Province (Grant No. 2022RC174 to JJ Zhou).

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Author notes

  1. Meng Luo, Yao Jin, and Chunjing Xu have contributed equally to this work.

Authors and Affiliations

  1. Department of Breast Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Meng Luo, Yao Jin, Huihui Chen, Kun Zhang, Qiang Chen, Jinglu Lu, Jing Wang, Hao Deng, Weili Jin, Yiding Chen & Jiaojiao Zhou

  2. The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China

    Meng Luo, Jing Wang, Jia Huang, Shu Zheng, Yiding Chen & Jiaojiao Zhou

  3. Department of Breast Surgery, Zhejiang Hospital, Hangzhou, China

    Chunjing Xu

  4. Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Chencan Jin

  5. Cancer Center, Zhejiang University, Hangzhou, China

    Yiding Chen & Jiaojiao Zhou

Authors
  1. Meng Luo
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Contributions

JZ and YC planned and designed this study. JZ, ML and YJ drew the outline of the study. YJ, JZ and ML wrote the manuscript. YJ drew the figures and tables. ML, CX, HC and YJ collected the clinical data of patients and performed the data analysis. KZ, JL, QC, JC, JW, JH, WJ and HD participated in following up the patients’ survival and recurrence. YJ and ML participated in searching relevant studies and performed the meta-analysis. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yiding Chen or Jiaojiao Zhou.

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Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethics approval

This study was approved by the Ethics Committee of our hospital (Approval No: 2020–363) with waiver of informed consent.

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Written informed consent was obtained from the parents.

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Luo, M., Jin, Y., Xu, C. et al. Postmastectomy radiotherapy in patients with T1-2N1 breast cancer: a single center experience and a meta-analysis. J Cancer Res Clin Oncol 149, 9979–9990 (2023). https://doi.org/10.1007/s00432-023-04908-7

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