Evaluation of the benefit of post‑mastectomy radiotherapy in patients with early‑stage breast cancer: A propensity score matching study

Shi,Wenjie; Luo,Youhong; Zhao,Dongkang; Huang,Hao; Pang,Weiyi

doi:10.3892/ol.2019.10197

Evaluation of the benefit of post‑mastectomy radiotherapy in patients with early‑stage breast cancer: A propensity score matching study

Authors:
- Wenjie Shi
- Youhong Luo
- Dongkang Zhao
- Hao Huang
- Weiyi Pang
View Affiliations

Affiliations: Department of Breast Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000, P.R. China, Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi 541000, P.R. China
Published online on: March 29, 2019 https://doi.org/10.3892/ol.2019.10197
Pages: 4851-4858
Copyright: © Shi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to evaluate the significance of post‑mastectomy radiotherapy (PMRT) in patients with early stage (T1‑2) breast cancer. The Surveillance, Epidemiology, and End Results database was searched, and data on female patients with early stage (T1‑2) breast cancer with 1‑3 positive axillary lymph nodes (LNs) were extracted. Patients were subdivided into two groups: Those who had received PMRT and those who had not (no PMRT). Data from the two groups were analyzed in order to identify associations between PMRT status, breast cancer‑specific survival (BCSS) probability and overall survival (OS) probability using multivariate Cox proportional hazards regression and propensity score matching models. A total of 7,316 patients were included in the analysis. Prior to propensity score matching, outcome probabilities were increased in the PMRT group, compared with the no PMRT group (BCSS probabilities: 92.0 vs. 90.1%, respectively, P=0.015; OS probabilities: 89.8 vs. 86.0%, respectively, P<0.001). In multivariate analyses, tumor location was not identified as being a risk factor for BCSS (hazard ratio, 0.917; 95% confidence interval, 0.772‑1.090; P=0.326). Following propensity score matching, differences between the two treatment groups (PMRT and no PMRT) in terms of their BCSS scores remained significant (93.7 vs. 90.1%, respectively; P=0.007). Compared with the no PMRT group, the OS probabilities of the PMRT group were increased (89.4 vs. 86.0%; P=0.025). In conclusion, the present results indicated that PMRT may benefit the prognosis of patients with breast cancer with early stage disease (T1‑2), and those with one to three positive axillary LNs.

View Figures

View References

1	Anastasiadi Z, Lianos GD, Ignatiadou E, Harissis HV and Mitsis M: Breast cancer in young women: An overview. Updates Surg. 69:313–317. 2017. View Article : Google Scholar : PubMed/NCBI
2	Dimitrova N, Znaor A, Agius D, Eser S, Sekerija M, Ryzhov A, Primic-Žakelj M and Coebergh JW; SEE+ Working Group, : Breast cancer in South-Eastern European countries since 2000: Rising incidence and decreasing mortality at young and middle ages. Eur J Cancer. 83:43–55. 2017. View Article : Google Scholar : PubMed/NCBI
3	Mogal HD, Clark C, Dodson R, Fino NF and Howard-Mcnatt M: Outcomes after mastectomy and lumpectomy in elderly patients with early-stage breast cancer. Ann Surg Oncol. 24:100–107. 2017. View Article : Google Scholar : PubMed/NCBI
4	Mahmood U, Hanlon AL, Koshy M, Buras R, Chumsri S, Tkaczuk KH, Cheston SB, Regine WF and Feigenberg SJ: Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 20:1436–1443. 2013. View Article : Google Scholar : PubMed/NCBI
5	Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M and Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 347:1227–1232. 2002. View Article : Google Scholar : PubMed/NCBI
6	Ursino S, Fiorica F, Mazzotti V, Delishaj D, Cristaudo A, Spagnesi S, Laliscia C, Pasqualetti F, Fontana A, Ghilli M, et al: The role of clinicopathologic and molecular prognostic factors in the post-mastectomy radiotherapy (PMRT): A retrospective analysis of 912 patients. Eur Rev Med Pharmacol Sci. 21:2157–2166. 2017.PubMed/NCBI
7	Zhang X, Sun Y and Zhang L: Influence of postoperative radiotherapy on the prognosis of patients with breast cancer in T_1- T_2. J Modern Oncol. 2016.
8	Li XP, Bai GP and Wang ZG: Influence factors on the quality of life for postoperative radiotherapy patients with breast cancer. Anhui Medical & Pharmaceutical Journal. 2017.
9	Bloomfield DJ; Core Group facilitated by The Royal College of Radiologists, : Development of postoperative radiotherapy for breast cancer: UK consensus statements-a model of patient, clinical and commissioner engagement? Clin Oncol (R Coll Radiol). 29:639–641. 2017. View Article : Google Scholar : PubMed/NCBI
10	Wang S, He M, Jin Y, Wyss R, Shin H, Ma Y, Keeton S, Fireman B, Karami S, Major JM, et al: A review of the performance of different methods for propensity score matched subgroup analyses and a summary of their application in peer-reviewed research studies. Pharmacoepidemiol Drug Saf. 26:1507–1512. 2017. View Article : Google Scholar : PubMed/NCBI
11	Francis SR, Frandsen J, Kokeny K, Gaffney D and Poppe M: (P011) postmastectomy radiotherapy for T3N0 breast cancers: A national cancer database analysis. Int J Radiation Oncol Biol Phy. 98:E182017. View Article : Google Scholar
12	Park HJ, Shin KH, Kim JH, Ahn SD, Kim SS, Kim YB, Park W, Kim YJ, Shin HS, Kim JH, et al: Possible benefits from post-mastectomy radiotherapy in node-negative breast cancer patients: A multicenter analysis in Korea (KROG 14–22). Oncotarget. 8:59800–59809. 2017.PubMed/NCBI
13	Forissier V, Tallet A, Cohen M, Classe JM, Reyal F, Chopin N, Mazouni C, Gimbergues P, Daraï E, Colombo PE, et al: Is post-mastectomy radiation therapy contributive in pN0-1mi breast cancer patients? Results of a French multi-centric cohort. Eur J Cancer. 87:47–57. 2017. View Article : Google Scholar : PubMed/NCBI
14	Belkacémi Y, Comet B, Hannoun-Levi JM, Villette S, Marsiglia H, Leblanc-Onfroy M, Delalande B, Azria D and Dubois JB: Accelerated partial breast irradiation: A concept to individualize treatment in breast cancer. Cancer Radiother. 11:287–295. 2007.(In French). View Article : Google Scholar : PubMed/NCBI
15	Zhou SY, Xue Q, Ying JM, Hu XS, Yang JL, Lin H and Shi YK: The clinical and pathological features, biomarker characteristics and prognosis analysis of lung adenosquamous carcinoma. Zhonghua Zhong Liu Za Zhi. 41:50–55. 2019.(In Chinese). PubMed/NCBI
16	Thoemmes FJ and Kim ES: A systematic review of propensity score methods in the social sciences. Multivariate Behav Res. 46:90–118. 2011. View Article : Google Scholar : PubMed/NCBI
17	Li FQ and Hui MA: Sensitivity analysis on the propensity score matching method. Statistics and Information Forum. 2009.
18	Fauser D and Bethge M: Propensity score methods to estimate treatment effects: An opportunity for rehabilitation service research. Rehabilitation (Stuttg). 58:50–58. 2019.(In German). PubMed/NCBI
19	Cuccurullo V and Mansi L: AJCC cancer staging handbook: From the AJCC cancer staging manual (7th edition). Eur J Nucl Med Mol Imag. 38:408. 2011. View Article : Google Scholar
20	Pike MC and Morrow RH: Statistical analysis of patient-control studies in epidemiology. Factor under investigation an all-or-none variable. Br J Prev Soc Med. 24:42–44. 1970.PubMed/NCBI
21	Pike MC, Casagrande J and Smith PG: Statistical analysis of individually matched case-control studies in epidemiology: Factor under study a discrete variable taking multiple values. Br J Prev Soc Med. 29:196–201. 1975.PubMed/NCBI
22	Kim CS and Algan O: Radiation Therapy, Breast Cancer Early Stage. Stat Pearls Stat Pearls Publishing Stat Pearls Publishing, LLC. Treasure Island (FL): 2017.
23	Pérez M, Schootman M, Hall LE and Jeffe DB: Accelerated partial breast irradiation compared with whole breast radiation therapy: A breast cancer cohort study measuring change in radiation side-effects severity and quality of life. Breast Cancer Res Treat. 162:329–342. 2017. View Article : Google Scholar : PubMed/NCBI
24	Huo D, Hou N, Jaskowiak N, Winchester DJ, Winchester DP and Yao K: Use of postmastectomy radiotherapy and survival rates for breast cancer patients with T1-T2 and one to three positive lymph nodes. Ann Surg Oncol. 22:4295–4304. 2015. View Article : Google Scholar : PubMed/NCBI
25	Kindts I, Buelens P, Laenen A, Van Limbergen E, Janssen H, Wildiers H and Weltens C: Omitting radiation therapy in women with triple-negative breast cancer leads to worse breast cancer-specific survival. Breast. 32:18–25. 2017. View Article : Google Scholar : PubMed/NCBI
26	Kim B, Kwon J and Kim K: Evaluation of the benefit of radiotherapy in patients with occult breast cancer: A population-based analysis of the SEER database. Cancer Res Treat. 50:551–561. 2018. View Article : Google Scholar : PubMed/NCBI
27	Yang J, Tang S, Zhou Y, Qiu J, Zhang J, Zhu S and Lv Q: Prognostic implication of the primary tumor location in early-stage breast cancer: Focus on lower inner zone. Breast Cancer. 25:100–107. 2018. View Article : Google Scholar : PubMed/NCBI
28	Hwang KT, Kim J, Kim EK, Jung SH, Sohn G, Kim SI, Jeong J, Lee HJ, Park JH and Oh S; Korean Breast Cancer Society, : Poor prognosis of lower inner quadrant in lymph node-negative breast cancer patients who received no chemotherapy: A study based on nationwide korean breast cancer registry database. Clin Breast Cancer. 17:e169–e184. 2017. View Article : Google Scholar : PubMed/NCBI
29	Dawood S, Lei X, Dent R, Gupta S, Sirohi B, Cortes J, Cristofanilli M, Buchholz T and Gonzalez-Angulo AM: Survival of women with inflammatory breast cancer: A large population-based study. Ann Oncol. 25:1143–1151. 2014. View Article : Google Scholar : PubMed/NCBI
30	DeBono NL, Robinson WR, Lund JL, Tse CK, Moorman PG, Olshan AF and Troester MA: Race, menopausal hormone therapy, and invasive breast cancer in the carolina breast cancer study. J Womens Health (Larchmt). 27:377–386. 2018. View Article : Google Scholar : PubMed/NCBI
31	Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN and Valero V: Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma. J Clin Oncol. 25:4952–4960. 2007. View Article : Google Scholar : PubMed/NCBI
32	Howell A, Anderson AS, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, Gescher AJ, Key TJ, Saxton JM and Harvie MN: Risk determination and prevention of breast cancer. Breast Cancer Res. 16:4462014. View Article : Google Scholar : PubMed/NCBI
33	Park HL, Chang J, Lal G, Lal K, Ziogas A and Anton-Culver H: Trends in treatment patterns and clinical outcomes in young women diagnosed with ductal carcinoma in situ. Clin Breast Cancer. 18:e179–e185. 2018. View Article : Google Scholar : PubMed/NCBI
34	Chow E: Radiation treatment for breast cancer. Recent advances. Can Fam Physician. 48:1065–1069. 2002.PubMed/NCBI
35	Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK and Yates JW: Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 285:885–892. 2001. View Article : Google Scholar : PubMed/NCBI
36	von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC and Vandenbroucke JP; STROBE Initiative, : The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Prev Med. 45:247–251. 2007. View Article : Google Scholar : PubMed/NCBI
37	Seki T, Jinno H, Okabayashi K, Murata T, Matsumoto A, Takahashi M, Hayashida T and Kitagawa Y: Comparison of oncological safety between nipple sparing mastectomy and total mastectomy using propensity score matching. Ann R Coll Surg Engl. 97:291–297. 2015. View Article : Google Scholar : PubMed/NCBI