Influence of Postmastectomy Radiotherapy on Overall Survival in Patients With Clinical Prognostic Stage I-III Breast Cancer With Positive Responses and Achieving YPN0 Following Neoadjuvant Therapy: A Propensity Score Matching Based on the SEER Database

IF 2.5 3区医学 Q2 ONCOLOGY Clinical breast cancer Pub Date : 2024-12-19 DOI:10.1016/j.clbc.2024.12.010

YuFeng Zhang , GuoDong Wang , Jia Si , MaoYi Xu

{"title":"Influence of Postmastectomy Radiotherapy on Overall Survival in Patients With Clinical Prognostic Stage I-III Breast Cancer With Positive Responses and Achieving YPN0 Following Neoadjuvant Therapy: A Propensity Score Matching Based on the SEER Database","authors":"YuFeng Zhang , GuoDong Wang , Jia Si , MaoYi Xu","doi":"10.1016/j.clbc.2024.12.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The role of postmastectomy radiotherapy (PMRT) in clinical prognostic stage I-III breast cancer patients with positive responses and achieving ypN0 after Neoadjuvant therapy (NAT) is controversial.</div></div><div><h3>Methods</h3><div>3557 patients with TNM clinical prognostic stage (AJCC 8th Edition) I-III breast cancer with positive responses and achieving ypN0 following neoadjuvant therapy were selected from the Surveillance, Epidemiology, and End Results (SEER) database and followed through the end of 2020. COX proportional hazards models were employed to examine the associations between clinical or pathological parameters and OS. Propensity score matching (PSM) was employed to control for confounding variables and multiple association inference models were used for progressive sensitivity analysis.</div></div><div><h3>Results</h3><div>In the multivariate analysis, PMRT did not demonstrate a significant improvement in OS (<em>P</em> = .127), while in univariate analysis, it was linked to worse OS (<em>P</em> < .001). PSM and multiple association inference models indicated that PMRT did not confer any significant improvement in patients' OS (all <em>P</em> > .05). Further stratified analysis of the prematch subgroup revealed that PMRT was linked to the 68% lower risk of mortality in patients with the cN3 subgroup (HR: 0.32; 95%CI, 0.11-0.97), and expressly enhanced the OS in cN3 subgroup patients with ER-, PR-, HER-2- status, and PR to NAT.</div></div><div><h3>Conclusions</h3><div>Our research indicated that PMRT did not show any survival benefits for clinical prognostic stage I-III breast cancer patients who had positive responses and achieved ypN0 after NAT. PMRT was linked to the reduction in mortality among patients in the cN3 subgroup.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 4","pages":"Pages e368-e382"},"PeriodicalIF":2.5000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical breast cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1526820924003586","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The role of postmastectomy radiotherapy (PMRT) in clinical prognostic stage I-III breast cancer patients with positive responses and achieving ypN0 after Neoadjuvant therapy (NAT) is controversial.

Methods

3557 patients with TNM clinical prognostic stage (AJCC 8th Edition) I-III breast cancer with positive responses and achieving ypN0 following neoadjuvant therapy were selected from the Surveillance, Epidemiology, and End Results (SEER) database and followed through the end of 2020. COX proportional hazards models were employed to examine the associations between clinical or pathological parameters and OS. Propensity score matching (PSM) was employed to control for confounding variables and multiple association inference models were used for progressive sensitivity analysis.

Results

In the multivariate analysis, PMRT did not demonstrate a significant improvement in OS (P = .127), while in univariate analysis, it was linked to worse OS (P < .001). PSM and multiple association inference models indicated that PMRT did not confer any significant improvement in patients' OS (all P > .05). Further stratified analysis of the prematch subgroup revealed that PMRT was linked to the 68% lower risk of mortality in patients with the cN3 subgroup (HR: 0.32; 95%CI, 0.11-0.97), and expressly enhanced the OS in cN3 subgroup patients with ER-, PR-, HER-2- status, and PR to NAT.

Conclusions

Our research indicated that PMRT did not show any survival benefits for clinical prognostic stage I-III breast cancer patients who had positive responses and achieved ypN0 after NAT. PMRT was linked to the reduction in mortality among patients in the cN3 subgroup.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

乳房切除术后放疗对新辅助治疗后阳性反应达到YPN0的临床预后I-III期乳腺癌患者总生存率的影响：基于SEER数据库的倾向评分匹配

简介：乳房切除术后放射治疗（PMRT）在临床预后I-III期乳腺癌患者新辅助治疗（NAT）后反应阳性并达到ypN0的作用存在争议。方法：从监测、流行病学和最终结果（SEER）数据库中选择3557例TNM临床预后期（AJCC第8版）I-III型乳腺癌患者，经新辅助治疗后阳性反应并达到ypN0，随访至2020年底。采用COX比例风险模型检验临床或病理参数与OS之间的关系。采用倾向得分匹配（PSM）控制混杂变量，采用多关联推理模型进行逐步敏感性分析。结果：在多因素分析中，PMRT对OS没有显著改善（P = .127），而在单因素分析中，PMRT与更差的OS相关（P < .001）。PSM和多重关联推断模型显示PMRT对患者OS没有任何显著改善（均P < 0.05）。对配对前亚组的进一步分层分析显示，PMRT与cN3亚组患者死亡风险降低68%相关(HR: 0.32；95%CI, 0.11-0.97)，并明确提高了具有ER-， PR-， HER-2-状态和PR到NAT的cN3亚组患者的OS。结论：我们的研究表明，PMRT对临床预后I-III期乳腺癌患者没有任何生存益处，这些患者在NAT后有阳性反应并达到ypN0。PMRT与cN3亚组患者死亡率的降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.