Radiotherapy after surgery has significant survival benefits for patients with triple-negative breast cancer

Yi Yao, Yuxin Chu, Bin Xu, Qinyong Hu, Qibin Song, Yi Yao, Yuxin Chu, Bin Xu, Qinyong Hu, Qibin Song

Abstract

Objectives: The value of adjuvant radiotherapy for triple-negative breast cancer (TNBC) has been controversial recently. This study aims to clarify the influence of radiotherapy on the survival of TNBC patients after surgery based on a large population analysis.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was exploited to select eligible patients from 2010 to 2014. The categorical variables were examined by chi-square tests. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared among patients who received or not received adjuvant radiotherapy after surgery by Kaplan-Meier method with log-rank test. Univariate and multivariate survival analysis of BCSS and OS were performed using the Cox proportional hazard model.

Results: Totally 22 802 patients were enrolled in this study, of which 10 905 patients received radiotherapy after surgery while 11 897 patients did not receive radiotherapy. Compared with those patients who did not receive radiotherapy, the radiation group had a larger proportion of tumor size <2.0 cm (45.8% vs 38.8%) and chemotherapy (82.5% vs 67.4%). The Kaplan-Meier plots displayed that patients in the radiation group had better survival than the no radiation group in both BCSS and OS (P < 0.001, respectively). In univariate Cox analysis of BCSS, age 40-60, married status, white and other race, chemotherapy, radiation, and surgery were associated with better survival (HR < 1, P < 0.05). Specifically, patients who received radiotherapy exhibited better BCSS (HR = 0.52, 95% CI = 0.48-0.57, P < 0.001). After adjusting for confounding factors by multivariable Cox regression analysis, receipt of radiotherapy was still associated with improved BCSS (HR = 0.79, 95% CI = 0.72-0.87, P < 0.001). Survival analysis of OS produced similar results. Generally, these data indicate that radiotherapy after surgery has significant survival benefits for the TNBC patients.

Conclusions: This study has confirmed the survival advantage of adjuvant radiotherapy for the TNBC patients. These findings may optimize the current individualized treatment decisions for this patient population.

Keywords: radiotherapy; surgery; survival; triple-negative breast cancer.

© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
The flowchart of patients’ selection from the SEER database
Figure 2
Figure 2
Survival curves with the log‐rank tests of (A) breast cancer‐specific survival (P < 0.001) and (B) overall survival (P < 0.001)
Figure 3
Figure 3
Survival curves with the log‐rank tests of breast cancer‐specific survival for T1‐T2 population (A) and T3‐T4 population (B)
Figure 4
Figure 4
Survival curves with the log‐rank tests of breast cancer‐specific survival for partial mastectomy (A), total mastectomy (B), and modified radical mastectomy (C)

References

    1. Wang L, Hu X, Wang P, Shao Z‐M. Integrative 3' untranslated region‐based model to identify patients with low risk of axillary lymph node metastasis in operable triple‐negative breast cancer. Oncologist. 2018;23:1‐9.
    1. Souad H, Zahia F, Abdelhak L, Karima S, Dalila S, et al. Descriptive study of triple negative breast cancer in Eastern Algeria. Pan Afr Med J. 2018;29:45.
    1. Gong CC, Ma G, Hu XC, et al. Pretreatment 18F‐FDG uptake heterogeneity predicts treatment outcome of first‐line chemotherapy in patients with metastatic triple negative breast cancer. Oncologist. 2018;23(10):1144‐1152.
    1. Martin AM, Cagney DN, Catalano PJ, et al. Brain metastases in newly diagnosed breast cancer: a population‐based study. JAMA Oncol. 2017;3(8):1069‐1077.
    1. Suhani, Parshad R, Kazi M, et al. Triple‐negative breast cancers: are they always different from nontriple‐negative breast cancers? An experience from a tertiary center in India. Indian J Cancer. 2017;54(4):658‐663.
    1. Kim YJ, Kim JS, Kim IA. Molecular subtype predicts incidence and prognosis of brain metastasis from breast cancer in SEER database. J Cancer Res Clin Oncol. 2018;144(9):1803‐1816.
    1. Abdulkarim BS, Cuartero J, Hanson J, Deschênes J, Lesniak D, Sabri S. Increased risk of locoregional recurrence for women with T1–2N0 triple‐negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast‐conserving therapy. J Clin Oncol. 2011;29(21):2852‐2858.
    1. Khalifa J, Duprez‐Paumier R, Filleron T, et al. Outcome of pN0 triple‐negative breast cancer with or without lymph node irradiation: a single institution experience. Breast J. 2016;22(5):510‐519.
    1. Moran MS. Radiation therapy in the locoregional treatment of triple‐negative breast cancer. Lancet Oncol. 2015;16(3):e113‐122.
    1. Kyndi M, Sørensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J. 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(9):1419‐1426.
    1. Bhoo‐Pathy N, Verkooijen HM, Wong FY, et al. Prognostic role of adjuvant radiotherapy in triple‐negative breast cancer: a historical cohort study. Int J Cancer. 2015;137(10):2504‐2512.
    1. O'Rorke MA, Murray LJ, Brand JS, Bhoo‐Pathy N. The value of adjuvant radiotherapy on survival and recurrence in triple‐negative breast cancer: a systematic review and meta‐analysis of 5507 patients. Cancer Treat Rev. 2016;47:12‐21.
    1. Chen X, Xia F, Luo J, et al. Postmastectomy radiotherapy reduces locoregional and disease recurrence in patients with stage II‐III triple‐negative breast cancer treated with neoadjuvant chemotherapy and mastectomy. Onco Targets Ther. 2018;11:1973‐1980.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere