Breast Cancer Presenting With Intravascular Tumor Emboli in Axillary Soft Tissue: Recurrence Risk and Radiation Therapy Outcomes

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2024-04-15 DOI:10.1016/j.adro.2024.101508

Reith R. Sarkar MD , Jessica A. Lavery PhD , Zhigang Zhang PhD , Boris A. Mueller MD, MPH , Melissa Zinovoy MD , John J. Cuaron MD , Beryl McCormick MD , Atif J. Khan MD , Simon N. Powell MD, PhD , Hannah Y. Wen MD , Lior Z. Braunstein MD

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Abstract

Purpose

Intravascular tumor emboli in axillary soft tissue (ITE) is a rare pathologic finding in breast cancer and is associated with higher axillary nodal disease burden. The independent prognostic and predictive value of this entity is unknown, as is the role of radiation therapy for ITE.

Methods and Materials

We analyzed a prospectively maintained database of breast cancer patients treated from 1992 to 2020. Patients with ITE were matched to those without (1:2) based on propensity scores to control for potential confounding factors. Locoregional (LRR) and distant recurrence (DR) were evaluated using competing risks methods accounting for death as a competing event. Overall survival (OS) and disease-free survival (DFS) were evaluated by Cox regression models. Among patients with ITE, we also evaluated whether RT improved outcomes.

Results

Among 2377 total patients, 129 had ITE, of whom 126 were propensity score matched to 252 without ITE. Median follow-up from time of surgery was 5.5 years (IQR 2.3, 9.7). There were no statistically significant differences in the 5-year incidence of LRR between groups (5.4% [95% CI, 1.6%-13%] with ITE vs 10% [95% CI, 6.7%-15%] without, P = .53) or DR (24% [95% CI, 15% 35%] with ITE vs 21% [95% CI, 16%-27%] without, P = .51). Five-year OS and DFS did not differ between groups (P > .9 for both comparisons, patients with ITE vs without ITE). In analyzing the effect of RT among patients with ITE, receipt of RT was associated with significantly improved DFS (HR, 0.34, 95% CI, 0.12-0.93, P = .04).

Conclusions

Patients with ITE do not exhibit significantly worse LRR, DR, DFS, or OS compared with a propensity-score-matched cohort without ITE. However, among patients with ITE, those who received RT demonstrated significantly improved DFS. Larger studies with longer follow-up are needed to evaluate the prognostic and predictive implications of ITE.

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腋窝软组织中出现血管内肿瘤栓子的乳腺癌：复发风险和放疗结果

目的腋窝软组织内的血管肿瘤栓子（ITE）是乳腺癌中一种罕见的病理发现，与较高的腋窝结节疾病负担有关。这一实体的独立预后和预测价值以及放疗对 ITE 的作用尚不清楚。方法和材料我们分析了一个前瞻性维护的数据库，该数据库收录了 1992 年至 2020 年接受治疗的乳腺癌患者。根据倾向评分将患有 ITE 的患者与未患有 ITE 的患者进行配对（1:2），以控制潜在的混杂因素。采用竞争风险方法对局部复发（LRR）和远处复发（DR）进行评估，将死亡作为竞争事件。总生存期（OS）和无病生存期（DFS）通过 Cox 回归模型进行评估。在患有 ITE 的患者中，我们还评估了 RT 是否能改善预后。结果在 2377 例患者中，129 例患有 ITE，其中 126 例与 252 例无 ITE 的患者进行了倾向评分匹配。从手术时间算起，中位随访时间为 5.5 年（IQR 2.3，9.7）。各组间的 5 年 LRR 发生率（有 ITE 的为 5.4% [95% CI, 1.6%-13%] vs 无 ITE 的为 10% [95% CI, 6.7%-15%], P = .53）或 DR 发生率（有 ITE 的为 24% [95% CI, 15% 35%] vs 无 ITE 的为 21% [95% CI, 16%-27%], P = .51）差异无统计学意义。各组间的五年期OS和DFS无差异（两组间比较，有ITE与无ITE患者的P均为0.9）。在分析 RT 对 ITE 患者的影响时，接受 RT 与 DFS 的显著改善相关（HR，0.34，95% CI，0.12-0.93，P = .04）。然而，在ITE患者中，接受RT治疗的患者的DFS明显改善。要评估ITE对预后和预测的影响，还需要进行更大规模、更长时间的随访研究。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.