Risk stratification for prediction of locoregional recurrence in patients with pathologic T1–2N0 breast cancer after mastectomy

Abstract

Background Previous studies have revealed that nearly 15–20% of selected high-risk T1–2N0 breast cancers developed LRR after mastectomy. This study is aim to indentify the risk factors of locoregional recurrence (LRR) in patients with pathologic T1–2N0 breast cancer after mastectomy in a real-world and distinguish individuals who warrant postmastectomy radiotherapy (PMRT). Methods Female patients treated from 1999 to 2014 in National Cancer Center of China were retrospectively reviewed. A competing risk model was developed to estimate the cumulative incidence of LRR with death treated as a competing event. Results A total of 4841 patients were eligible. All underwent mastectomy plus axillary nodes dissection or sentinel node biopsy without PMRT. With a median follow-up of 56.4 months (range, 1–222 months), the 5-year LRR rate was 3.9%.Besides treatment era, age ≤ 40 years old (p < 0.001, hazard ratio [HR] = 2.262), tumor located in inner quadrant (p < 0.001, HR = 2.236), T2 stage (p = 0.020, HR = 1.419), and negative expressions of estrogen receptor (ER) and progesterone receptor (PR) (p = 0.032, HR = 1.485), were patients-related independent risk factors for LRR. The 5-year LRR rates were 1.7, 3.5, and 15.0% for patients with zero, 1–2, and 3–4 risk factors (p < 0.001). Conclusions Risk Stratification based on age, T stage, ER/PR status and tumor location can stratify patients with pT1–2 N0 breast cancer into subgroups with different risk of LRR. PMRT might be suggested for patients with 3–4 risk factors.

Cost‐effectiveness of Choosing Wisely guidelines for axillary observation in women older than age 70 years with hormone receptor–positive, clinically node‐negative, operable breast tumors

“…The probabilities of pathologic nodal stage N0, N1, N2, or N3 disease on SLNB were determined from clinical trial results of patients undergoing full axillary dissection in this population (Table 1). 5,7 Annual health‐state transition probabilities were determined from pragmatic clinical trial data and their external validation studies 5,7,10,12,17‐22,42 . Cumulative incidences for the outcomes of interest reported in these studies including recurrence, metastases, and death were converted to rates and subsequently to annual probabilities using rate to probability equations as previously described (Supporting Methods 2, Supporting Table 2).…”

“…5,7 Annual health-state transition probabilities were determined from pragmatic clinical trial data and their external validation studies. 5,7,10,12,[17][18][19][20][21][22]42 Cumulative incidences for the outcomes of interest reported in these studies including recurrence, metastases, and death were converted to rates and subsequently to annual probabilities using rate to probability equations as previously described…”

Breast Cancer Local Recurrence in Patients with and without Post-Mastectomy Immediate Breast Reconstruction: Systematic Review & Meta-Analysis Protocol

“…5 Tumor related factors such as human epidermal growth factor receptor 2 (HER-2) positive, triple negative, estrogen receptor (ER) and progesterone receptor (PR) negative, size of tumour, tumour grade, tumour located on inner quadrant, lymphovascular invasion close/ positive margins and more advanced disease are known to increase recurrence risks. 15,[19][20][21] The lack of clear conclusions in the literature regarding IBR complicates clinical decision-making and patient education. Conducting a systematic review and meta-analysis may provide valuable insights into this extensively debated issue.…”

Antitumor Immunity from Abdominal Flap-Embedded Therapeutic Cancer Vaccine

“…About 3.9% of early stage breast cancer patients suffered from loco-regional recurrence (LRR) after a 5-year follow-up in a large analysis including 4841 patients who underwent mastectomy. 1,7 The impairment of immunity by surgery and general anesthesia was a major reason of cancer recurrence and metastases. 8 Immune therapy is an effective strategy for cancer treatment, and has achieved great success in recent years.…”