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Mastectomy without radiotherapy: outcome analysis after 10 years of follow-up in a single institution

  • Epidemiology
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Abstract

The aim of this study was to identify the prognostic factors associated with the risk of loco-regional recurrence (LRR) of women undergoing mastectomy and complete axillary dissection without radiotherapy. We analyzed data from 650 women operated between 1997 and 2001 in a single institution. Median follow-up was 10 years. Overall survival was 89.8 % at 5 years and 76.6 % at 10 years. The 10-year cumulative incidence of LRRs was 10.0 % (5.0, 10.5, 15.8, and 18.5 % in patients with 0, 1–3, 4–9, and ≥10 positive lymph nodes (LNs), respectively). Sixty-two (9.5 %) LRRs were observed, 5 (0.8 %) of which occurred in the axillary LNs. Supraclavicular LNs recurrences (n = 16, 2.5 %) occurred more frequently in patients with four or more positive LNs, Ki-67 ≥ 20 % or extensive peritumoral vascular invasion (PVI). At multivariable analysis, nodal status was the only prognostic factor for local events, while nodal status, Ki-67 and PVI were significant prognostic factors for recurrences in the regional LNs. Moreover, within each category of positive LNs, high values of Ki-67 and extensive PVI were associated with the highest risk of LRR while low values of Ki-67 and absence of extensive PVI were associated with the lowest risk of LRR. Women with node-negative tumors have the lowest risk of LRR and represent the group of patients that might benefit the least from radiotherapy. PVI and Ki-67 might help tailoring PMRT indications among patients with positive LNs. Finally, the very low incidence of recurrences in the axillary LNs raises questions about the inclusion of the axilla in the radiation field.

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Conflict of interest

Authors have no conflict of interest.

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Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    E. Botteri & N. Rotmensz

  2. Department of Occupational Health, University of Milan, Milan, Italy

    E. Botteri

  3. Division of Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    O. Gentilini, P. Veronesi, S. Ratini, C. Fraga-Guedes, A. Toesca, C. Sangalli, A. Del Castillo & U. Veronesi

  4. Division of Plastic Surgery, European Institute of Oncology, Milan, Italy

    M. Rietjens

  5. Division of Pathology, European Institute of Oncology, Milan, Italy

    G. Viale

  6. School of Medicine, University of Milan, Milan, Italy

    G. Viale

  7. Division of Radiotherapy, European Institute of Oncology, Milan, Italy

    R. Orecchia

  8. Division of Medical Oncology, European Institute of Oncology, Milan, Italy

    A. Goldhirsch

Authors
  1. E. Botteri
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  2. O. Gentilini
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  3. N. Rotmensz
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  4. P. Veronesi
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  5. S. Ratini
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  6. C. Fraga-Guedes
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  7. A. Toesca
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  8. C. Sangalli
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  9. A. Del Castillo
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  10. M. Rietjens
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  11. G. Viale
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  12. R. Orecchia
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  13. A. Goldhirsch
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  14. U. Veronesi
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Corresponding author

Correspondence to O. Gentilini.

Additional information

E. Botteri and O. Gentilini contributed equally to this study.

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Botteri, E., Gentilini, O., Rotmensz, N. et al. Mastectomy without radiotherapy: outcome analysis after 10 years of follow-up in a single institution. Breast Cancer Res Treat 134, 1221–1228 (2012). https://doi.org/10.1007/s10549-012-2044-2

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  • DOI: https://doi.org/10.1007/s10549-012-2044-2

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