Should all breast cancer patients with four or more positive lymph nodes who underwent modified radical mastectomy be treated with postoperative radiotherapy? A population-based study.
Postmastectomy radiotherapy (PMRT) has become a standard adjuvant postoperative therapy for breast cancer patients with four or more positive lymph nodes. However, some studies have demonstrated that some subgroups of the breast cancer patients with four or more positive lymph nodes did not benefit substantially from PMRT. Therefore, it is of great necessity to identify whether all breast cancer patients with four or more positive lymph nodes who underwent modified radical mastectomy be treated with PMRT. In our study, we first established a prognostic model using the Surveillance Epidemiology and End Results (SEER) database between 1998 and 2001. Univariate and multivariate Cox models were used to assess the prognostic factors, and five risk factors individually associated with prognosis including AJCC stage, AJCC T, Grade, ER status, PR status. Prognostic index of PMRT were defined as the number of risk factor (NRF). The NRF scores correlated well with overall survival of PMRT even if the patients were in the sub-poor prognosis group. Then the prognostic model was validated using the SEER database between 2006 and 2009, and the same results were obtained. In conclusion, different from others studies, our study demonstrated that all patients with four or more positive lymph nodes after modified radical mastectomy need to be treated with PMRT ever if the patients belonged to AJCC T4 in a poor prognosis group.
School of Medicine, Shandong University, Jinan, 250012, China.|Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 250117, China.
Haiyong
H
Wang
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 250117, China.
Li
L
Kong
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Chenyue
C
Zhang
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 250117, China.
Dawei
D
Chen
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 250117, China.
Hui
H
Zhu
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 250117, China.
Jinming
J
Yu
D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011159:Population Surveillance; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis
SEER; breast cancer; mastectomy; positive lymph nodes; radiotherapy
Breast. 2012 Oct;21(5):657-61
22835918
Lancet. 1999 May 15;353(9165):1641-8
10335782
N Engl J Med. 1997 Oct 2;337(14):949-55
9395428
J Natl Cancer Inst. 2005 Jan 19;97(2):116-26
15657341
Lancet. 2005 Dec 17;366(9503):2087-106
16360786
Cancer. 1982 Mar 15;49(6):1316-9
7037160
Strahlenther Onkol. 2014 Aug;190(8):705-14
24888511
Ann Oncol. 2016 May;27(5):818-27
26861597
Clin Breast Cancer. 2016 Aug;16(4):319-26
26943990
J Clin Oncol. 2005 Jan 1;23(1):5-7
15545662
J Clin Pathol. 2004 Aug;57(8):845-8
15280406
Eur J Surg Oncol. 2006 Dec;32(10):1082-8
16887320
Oncotarget. 2016 Apr 26;7(17):24848-59
26709538
Ann Surg Oncol. 2014 Feb;21(2):389-94
24132625
J Clin Oncol. 2007 May 20;25(15):2019-26
17420511
CA Cancer J Clin. 2015 Mar;65(2):87-108
25651787
Clin Breast Cancer. 2015 Apr;15(2):128-34
25459070
J Clin Oncol. 2004 Nov 1;22(21):4247-54
15452182
Curr Oncol. 2014 Oct;21(5):e685-90
25302039
Radiat Oncol. 2014 Dec 16;9:284
25511525
J Korean Med Sci. 2011 Aug;26(8):1014-22
21860551
Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1337-47
15817335
J Clin Oncol. 2000 Aug;18(15):2817-27
10920129
Int J Radiat Oncol Biol Phys. 1977 Nov-Dec;2(11-12):1061-7
599057
Ther Clin Risk Manag. 2014 Oct 09;10:867-74
25328402
Lancet. 2014 Jun 21;383(9935):2127-35
24656685
CA Cancer J Clin. 2014 Mar-Apr;64(2):135-52
24357525
Int J Clin Oncol. 2013 Feb;18(1):54-61
22068463
J Clin Oncol. 2000 Mar;18(6):1220-9
10715291
Ann Surg. 1970 Oct;172(4):711-32
4989839