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Is postmastectomy radiotherapy necessary for breast cancer patients with clinically node-positive downstaging to ypN0 after neoadjuvant chemotherapy?

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Abstract

Purpose

The significance of postmastectomy radiotherapy (PMRT) in breast cancer patients who initially have clinically node-positive (cN +) status but achieve downstaging to ypN0 following neoadjuvant chemotherapy (NAC) remains uncertain. This study aims to assess the impact of PMRT in this patient subset.

Methods

Patients were enrolled from West China Hospital, Sichuan University from 2008 to 2019. Overall survival (OS), Locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were estimated using the Kaplan–Meier method and assessed with the log-rank test. The impact of PMRT was further analyzed by the Cox proportional hazards model. Propensity score matching (PSM) was performed to reduce the selection bias.

Results

Of the 333 eligible patients, 189 (56.8%) received PMRT, and 144 (43.2%) did not. At a median follow-up period of 71 months, the five-year LRFS, DMFS, BCSS, and OS rates were 99.1%, 93.4%, 96.4%, and 94.3% for the entire cohort, respectively. Additionally, the 5-year LRFS, DMFS, BCSS, and OS rates were 98.9%, 93.8%, 96.7%, and 94.5% with PMRT and 99.2%, 91.3%, 94.9%, and 92.0% without PMRT, respectively (all p-values not statistically significant). After multivariate analysis, PMRT was not a significant risk factor for any of the endpoints. When further stratified by stage, PMRT did not show any survival benefit for patients with stage II-III diseases.

Conclusion

In the context of comprehensive treatments, PMRT might be exempted in ypN0 breast cancer patients. Further large-scale, randomized controlled studies are required to investigate the significance of PMRT in this patient subset.

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Data availability

The datasets are available from the corresponding author on reasonable request.

Abbreviations

NAC:

Neoadjuvant chemotherapy

PMRT:

Postmastectomy radiotherapy

ypN0:

Lymph node negativity

cN + :

Initially node-positive

pCR:

Pathologic complete responses

ER:

Estrogen receptor

PR:

Progesterone receptor

HER-2:

Human epidermal growth factor receptor 2

OS:

Overall survival

IMRT:

Intensity-modulated radiation therapy

LRFS:

Locoregional recurrence-free survival

DMFS:

Distant metastasis-free survival

BCSS:

Breast cancer-specific survival

LRR:

Locoregional recurrence

PSM:

Propensity score matching

NCCN:

National Comprehensive Cancer Network

AJCC:

American Joint Committee on Cancer

NCDB:

National Cancer Data Base

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Funding

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

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Author notes

  1. Chen-feng Tan, Jun Wang and Xiao-rong Zhong have contributed equally to this work.

Authors and Affiliations

  1. Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Chen-feng Tan, Jun Wang, Ze-lei Dai, Zhong-zheng Xiang, Yuan-yuan Zeng, Xiao-yuan Wei, Ning-yue Xu & Lei Liu

  2. Breast Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Xiao-rong Zhong

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  1. Chen-feng Tan
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Contributions

The study conception and design were performed by JW, XZ and LL. Material preparation and data collection were performed by CT, ZD, ZX, YZ, XW and NX. Data analysis was conducted by CT, JW, ZD and LL. The first draft of the manuscript was written by CT and JW. XZ and LL commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lei Liu.

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Tan, Cf., Wang, J., Zhong, Xr. et al. Is postmastectomy radiotherapy necessary for breast cancer patients with clinically node-positive downstaging to ypN0 after neoadjuvant chemotherapy?. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07249-2

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