Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in n1 breast cancer treated with optimal systemic therapy: A multicenter analysis in Korea (KROG 14-23)

Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Ja Young Kim, Won Park, Yongbae Kim, Yeon Joo Kim, Jin Hee Kim, Kyubo Kim, Kyung Ran Park, Hyun Soo Shin, Bae Kwon Jeong, Sun Young Lee, Suzy Kim

Research output: Contribution to journalArticle

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Abstract

Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

Original languageEnglish
Pages (from-to)739-747
Number of pages9
JournalCancer Research and Treatment
Volume49
Issue number3
DOIs
Publication statusPublished - 2017 Jul 1

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Mastectomy
Korea
Radiotherapy
Breast Neoplasms
Recurrence
Therapeutics
Neoplasm Metastasis
Multivariate Analysis
Meta-Analysis
Lymph Nodes

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Park, Hae Jin ; Shin, Kyung Hwan ; Kim, Jin Ho ; Ahn, Seung Do ; Kim, Ja Young ; Park, Won ; Kim, Yongbae ; Kim, Yeon Joo ; Kim, Jin Hee ; Kim, Kyubo ; Park, Kyung Ran ; Shin, Hyun Soo ; Jeong, Bae Kwon ; Lee, Sun Young ; Kim, Suzy. / Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in n1 breast cancer treated with optimal systemic therapy : A multicenter analysis in Korea (KROG 14-23). In: Cancer Research and Treatment. 2017 ; Vol. 49, No. 3. pp. 739-747.
@article{c4f1a8a3029745b2833fc9d3c940552a,
title = "Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in n1 breast cancer treated with optimal systemic therapy: A multicenter analysis in Korea (KROG 14-23)",
abstract = "Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6{\%} had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1{\%} and 12.0{\%}, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6{\%} with 0-1 (n=606), 7.5{\%} with 2-3 (n=655), and 12.7{\%} with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1{\%} with 0-1, 15.0{\%} with 2-3, and 24.5{\%} with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.",
author = "Park, {Hae Jin} and Shin, {Kyung Hwan} and Kim, {Jin Ho} and Ahn, {Seung Do} and Kim, {Ja Young} and Won Park and Yongbae Kim and Kim, {Yeon Joo} and Kim, {Jin Hee} and Kyubo Kim and Park, {Kyung Ran} and Shin, {Hyun Soo} and Jeong, {Bae Kwon} and Lee, {Sun Young} and Suzy Kim",
year = "2017",
month = "7",
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doi = "10.4143/crt.2016.405",
language = "English",
volume = "49",
pages = "739--747",
journal = "Cancer Research and Treatment",
issn = "1598-2998",
publisher = "Korean Cancer Association",
number = "3",

}

Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in n1 breast cancer treated with optimal systemic therapy : A multicenter analysis in Korea (KROG 14-23). / Park, Hae Jin; Shin, Kyung Hwan; Kim, Jin Ho; Ahn, Seung Do; Kim, Ja Young; Park, Won; Kim, Yongbae; Kim, Yeon Joo; Kim, Jin Hee; Kim, Kyubo; Park, Kyung Ran; Shin, Hyun Soo; Jeong, Bae Kwon; Lee, Sun Young; Kim, Suzy.

In: Cancer Research and Treatment, Vol. 49, No. 3, 01.07.2017, p. 739-747.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in n1 breast cancer treated with optimal systemic therapy

T2 - A multicenter analysis in Korea (KROG 14-23)

AU - Park, Hae Jin

AU - Shin, Kyung Hwan

AU - Kim, Jin Ho

AU - Ahn, Seung Do

AU - Kim, Ja Young

AU - Park, Won

AU - Kim, Yongbae

AU - Kim, Yeon Joo

AU - Kim, Jin Hee

AU - Kim, Kyubo

AU - Park, Kyung Ran

AU - Shin, Hyun Soo

AU - Jeong, Bae Kwon

AU - Lee, Sun Young

AU - Kim, Suzy

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

AB - Purpose In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. Materials and Methods One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. Results After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. Conclusion Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

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