Identification of risk factors for locoregional recurrence in breast cancer patients with nodal stage n0 and n1: Who could benefit from post-mastectomy radiotherapy?

Eunjin Jwa, Kyung Hwan Shin, Hyeon Woo Lim, So Youn Jung, Seeyoun Lee, Han Sung Kang, Eunsook Lee, Young Hee Park

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23 Scopus citations

Abstract

Introduction The locoregional recurrence (LRR) rate was reported as high as approximately 20%in stage I-II breast cancer followingmastectomy. To investigate the risk factors for LRR in pT1-2N0-1 breast cancer patients treated withmastectomy but not radiation, and to define a subgroup of patients at high risk of LRR who may benefit from postmastectomy radiotherapy (PMRT). Methods and Materials In total, 390 patients with pT1-2N0M0 (n = 307) and pT1-2N1M0 (n = 83) breast cancer who underwent total mastectomy without adjuvant radiotherapy from 2002 to 2011 were enrolled in the study. Results After a median follow-up period of 5.6 years (range, 0.6-11.3 years), 21 patients had 18 systemic relapses and 12 LRRs including six in the chest wall and eight in the regional nodal area. The 5-year LRR-free survival (LRRFS) rates were 97.0% in pN0, 98.8%in pN1, and 97.4% in all patients. Multivariate analysis revealed that age < 50 years (Hazard Ratio, 11.4; p = 0.01) and no adjuvant chemotherapy (Hazard Ratio, 10.2; p = 0.04) were independent risk factors for LRR in pN0 patients. Using these factors, the 5-year LRRFS rates were 100% without any risk factors, 96.4% with one risk factor, and 86.7% with two risk factors. In pN1 patients, multivariate analysis revealed that having a hormone receptor negative tumor (Hazard Ratio, 18.3; p = 0.03) was the only independent risk factor for LRR. The 5-year LRRFS rates were 100.0% for luminal type, and 92.3%for non-luminal type cancer. Conclusion Patients with pT1-2N0-1 breast cancer who underwent total mastectomy without PMRT could be stratified by nodal stage and risk factors for LRR. PMRT may have of value for node negative patients aged less than 50 years and who are not treated with adjuvant chemotherapy, and for non-luminal type patients with one to three positive nodes.

Original languageEnglish
Article numbere0145463
JournalPLoS ONE
Volume10
Issue number12
DOIs
StatePublished - 1 Dec 2015

Bibliographical note

Publisher Copyright:
© 2015 Jwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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