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Mastectomy alone for pT1-2 pN0-1 breast cancer patients: when postmastectomy radiotherapy is indicated

  • Clinical trial
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Abstract

Purpose

To assess outcome of breast cancer (BC) stages pT1-2 N0-1 after mastectomy alone and to identify prognostic factors calling for the need of postmastectomy radiotherapy.

Methods

Patients who were not eligible for breast conserving surgery (BCS) were operated on with mastectomy between 1998 and 2008. Locoregional (LRR), distant (DM) control and breast cancer specific survival (BCSS) were retrospectively evaluated. Cumulative incidence (CI) of events was estimated according to Kalbfleisch and Prentice while Gray’s test tested difference. Kaplan–Meier method for survival and Cox proportional hazards model for univariable and multivariable analysis were used. A matched pair analysis between mastectomy alone and BCS plus whole breast irradiation (WBI), using the propensity score method, was performed.

Results

1281 pT1-2 N0 and 1081 pT1-2 N1 were identified. Median follow-up was 8.2 years (9.2 years for survival). Overall, LRR rate was low for both N0 and N1 subgroups (10-year CI, 8.8% and 10.9%, respectively). Young age, lymphovascular invasion and Ki-67 ≥ 20% were proved to be statistically significant prognostic factors at multivariable analysis. The combination of ≥ 2 risk factors increased LRR rate to ≥ 15%. Risk factors combination weighed on LRR rate more than nodal status itself. DM rate doubled moving from negative to positive nodal status (10-year CI 10.5% versus 20.3%, respectively). BCSS remained high in both N0 and N1 subgroups (10-year CI 92.4% versus 84.5%, respectively). Remarkably, all the molecular subtypes except Luminal A significantly affected DM and BCSS both in the N0 and N1 subgroups. Nodes number significantly impacted on DM and BCSS but not on locoregional control. In the matched pair analysis, WBI decreased nodal recurrence rate and improved distant control, without affecting survival.

Conclusions

Selected patients, namely those with at least two additional risk factors, presented high enough LRR risk to support the use of postmastectomy radiotherapy in both N0 and N1 subgroups. Moreover, the observation that radiotherapy may provide benefits that go beyond local control deserves to be further investigated.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The European Institute of Oncology, Milan, Italy is partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.

Funding

There were no sources of funding associated with this work.

Author information

Author notes

  1. Maria Cristina Leonardi and Ida Rosalia Scognamiglio are co-first authors. Barbara Alicja Jereczek-Fossa and Giovanni Corso are co-last authors.

Authors and Affiliations

  1. Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

    Maria Cristina Leonardi, Samantha Dicuonzo, Damaris Patricia Rojas, Maria Alessia Zerella, Anna Morra, Marianna Alessandra Gerardi, Mattia Zaffaroni, Cristiana Iuliana Fodor & Barbara Alicja Jereczek-Fossa

  2. Department of Advanced Biomedical Sciences, University “Federico II”, Napoli, Italy

    Ida Rosalia Scognamiglio & Roberto Pacelli

  3. Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Patrick Maisonneuve

  4. Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Alessandra De Scalzi, Antonia Girardi, Francesca Magnoni, Viviana Enrica Galimberti, Paolo Veronesi & Giovanni Corso

  5. Division of Medical Senology, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Emilia Montagna

  6. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Paolo Veronesi, Barbara Alicja Jereczek-Fossa & Giovanni Corso

  7. Scientific Direction, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Roberto Orecchia

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Contributions

All authors contributed to manuscript revision and read and approved the submitted version.

Corresponding author

Correspondence to Samantha Dicuonzo.

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Conflict of interest

M.C.L. and B.A.J.-F. received honorarium fees from Accuray Inc. outside the current work. The remaining authors declare no conflict of interest.

Ethical approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. This study has been approved by the Institutional Scientific Board of the European Institute of Oncology (IEO) following a notification to the IEO Ethics Committee (Identification Number 2641). All patients gave written informed consent for the treatment and anonymous use of their data for educational and research purposes.

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Leonardi, M.C., Scognamiglio, I.R., Maisonneuve, P. et al. Mastectomy alone for pT1-2 pN0-1 breast cancer patients: when postmastectomy radiotherapy is indicated. Breast Cancer Res Treat 188, 511–524 (2021). https://doi.org/10.1007/s10549-021-06227-2

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