Skip to main content

Advertisement

SpringerLink
Log in

Impact of Molecular Subtype on Locoregional Recurrence in Mastectomy Patients with T1–T2 Breast Cancer and 1–3 Positive Lymph Nodes

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postmastectomy radiation (PMRT) in T1–T2 tumors with 1–3 positive axillary lymph nodes (ALNs) is controversial. Impact of molecular subtype (MST) on locoregional recurrence (LRR) and PMRT benefit is uncertain. We examined the association between MST and LRR, recurrence-free survival (RFS), and overall survival (OS), in T1–T2 tumors with 1–3 positive ALNs.

Methods

From an institutional database, we identified mastectomy patients with 1–3 positive ALNs between 1995 and 2006. Patients who received neoadjuvant chemotherapy, had T3–T4 tumors, or ≥4 positive ALNs were excluded. MST was defined as: hormone receptor (HR)+/HER2−(luminal A/B), HR+/HER2+(luminal HER2), HR−/HER2+(HER2), and HR−/HER2−(basal). Kaplan–Meier method and Cox regression analysis were used to examine association between MST and LRR, RFS, and OS.

Results

This study included 884 patients (700 no PMRT, 141 PMRT): 72.8 % luminal A/B, 7.8 % luminal HER2, 6.8 % HER2, and 12.6 % basal. Median follow-up was 6.3 years; 39 LRRs occurred. Luminal A/B subtype had the smallest tumors (p = 0.03), lowest intraductal component (p = 0.01), histologic grade (p < 0.0001), lymphovascular invasion (LVI) (p = 0.008), and multifocality/multicentricity (p = 0.02). On univariate analyses, there was no association between MST and LRR. MST was associated with RFS and OS; the basal and HER2 subtype had the lowest RFS (p = 0.0002) and OS (p < 0.0001). On multivariate analysis, only age ≤50 years (p = 0.003) and presence of LVI (p = 0.0003) were predictive of LRR; MST was not (p = 0.38).

Conclusion

In patients with T1–T2 breast cancer and 1–3 positive lymph nodes who did not receive PMRT, MST was not an independent predictor of LRR and may not be useful in selecting PMRT candidates in that group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Reference

  1. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337:949–55.

    Article  CAS  PubMed  Google Scholar 

  2. Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–62.

    Article  CAS  PubMed  Google Scholar 

  3. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  4. Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353:1641–8.

    Article  CAS  PubMed  Google Scholar 

  5. Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999;17:1689–700.

    CAS  PubMed  Google Scholar 

  6. Sharma R, Bedrosian I, Lucci A, Hwang RF, Rourke LL, Qiao W, et al. Present-day locoregional control in patients with t1 or t2 breast cancer with 0 and 1–3 positive lymph nodes after mastectomy without radiotherapy. Ann Surg Oncol. 2010;17:2899–908.

    Article  PubMed  Google Scholar 

  7. Tendulkar RD, Rehman S, Shukla ME, Reddy CA, Moore H, Budd GT, et al. Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1–3 positive lymph nodes treated with modern systemic therapy. Int J Radiat Oncol Biol Phys. 2012;83:e577–81.

    Article  PubMed  Google Scholar 

  8. Jagsi R, Pierce L. Postmastectomy radiation therapy for patients with locally advanced breast cancer. Semin Radiat Oncol. 2009;19:236–43.

    Article  PubMed  Google Scholar 

  9. Truong PT, Olivotto IA, Kader HA, Panades M, Speers CH, Berthelet E. Selecting breast cancer patients with T1–T2 tumors and 1–3 positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61:1337–47.

    Article  PubMed  Google Scholar 

  10. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001;98:10869–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Sotiriou C, Neo SY, McShane LM, et al. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA. 2003;100:10393–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Van’t Veer LJ, Dai H, van de Vijver MJ, He YD, Hart AA, Mao M, et al. Gene expression profiling predicts clinical outcome of breast cancer. Nature. 2002;415:530–536.

    Article  Google Scholar 

  13. Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–69.

    CAS  PubMed  Google Scholar 

  14. National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2013, Clinical Practice guidelines in Oncology- Breast Cancer. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdff. Accessed 9 Feb 2013.

  15. Dragun AE, Huang B, Gupta S, Crew JB, Tucker TC. One decade later: trends and disparities in the application of post-mastectomy radiotherapy since the release of the American Society of Clinical Oncology clinical practice guidelines. Int J Radiat Oncol Biol Phys. 2012;83:e591–6.

    Article  PubMed  Google Scholar 

  16. Kyndi M, Sorensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J, et al. Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol. 2008;26:1419–26.

    Article  CAS  PubMed  Google Scholar 

  17. Nguyen PL, Taghian AG, Katz MS, Niemierko A, Abi Raad RF, Boon WL, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008;26:2373–2378.

    Article  PubMed  Google Scholar 

  18. Millar EK, Graham PH, O’Toole SA, McNeil CM, Browne L, Morey AL, et al. Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol. 2009;27:4701–8.

    Article  PubMed  Google Scholar 

  19. Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28:1684–91.

    Article  PubMed  Google Scholar 

  20. Wang SL, Li YX, Song YW, Wang WH, Jin J, Liu YP, et al. Triple-negative or HER2-positive status predicts higher rates of locoregional recurrence in node-positive breast cancer patients after mastectomy. Int J Radiat Oncol Biol Phys. 2011;80:1095–101.

    Article  PubMed  Google Scholar 

  21. Dominici LS, Mittendorf EA, Wang X, Liu J, Kuerer HM, Hunt KK, et al. Implications of constructed biologic subtype and its relationship to locoregional recurrence following mastectomy. Breast Cancer Res. 2012;14:R82.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673–84.

    Article  CAS  PubMed  Google Scholar 

  23. Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004;10:5367–74.

    Article  CAS  PubMed  Google Scholar 

  24. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295:2492–502.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded in part through NIH/NCI Cancer Center Support Grant P30 CA008748, the authors have no conflicts of interest to disclose, and the findings contained in this manuscript were presented in part at the 2013 Society of Surgical Oncology Annual Cancer Symposium on March 8, 2013.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Tracy-Ann Moo MD, Robert McMillan MPH, MD, Michelle Stempel MPH & Mahmoud El-Tamer MD

  2. Weill Cornell Medical College, New York, NY, USA

    Michele Lee BS

  3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Alice Ho MD

  4. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

Authors
  1. Tracy-Ann Moo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert McMillan MPH, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Lee BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelle Stempel MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alice Ho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sujata Patil PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mahmoud El-Tamer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mahmoud El-Tamer MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moo, TA., McMillan, R., Lee, M. et al. Impact of Molecular Subtype on Locoregional Recurrence in Mastectomy Patients with T1–T2 Breast Cancer and 1–3 Positive Lymph Nodes. Ann Surg Oncol 21, 1569–1574 (2014). https://doi.org/10.1245/s10434-014-3488-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3488-x

Keywords

Search

Navigation