Research article

Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients

Running title: BCS had better prognosis than mastectomy for early TNBC patients
  • Received: 28 March 2019 Accepted: 23 August 2019 Published: 26 September 2019
  • BackgroundTriple-negative breast cancer (TNBC) is a subtype of breast cancer with stronger invasive capacity. For the operation strategies of early staged (stage Ⅰ and stage Ⅱ) TNBC patients, BCS plus radiotherapy (BCS+RT), mastectomy only (MRM only) or MRM plus radiotherapy (MRM+RT) is feasible, but no clear conclusion has been made on the choice of these treatments. MethodsThe early staged TNBC patients (stage Ⅰ and stage Ⅱ) from the Surveillance, Epidemiology and End Results (SEER) program database between 1973 and 2014 were included in the study. Survival curves, univariate and multivariate cox proportional hazards models and propensity score weighting were applied to evaluate the prognostic impact among BCS+RT, MRM only and MRM+RT for patients. ResultsBoth overall and cancer-specific survival analysis showed that BCS+RT had better prognostic effect than MRM and MRM+RT in the cohort of early-staged triple-negative breast cancer patients (overall survival, P < 0.001; cancer-specific survival, P < 0.001). By taking all the risk factors into a multivariate cox proportional model, MRM and MRM+RT remained to have detrimental effect on the prognosis compared with BCS+RT as shown by either overall (HR = 1.742, CI = 1.387-2.188, P < 0.001; HR = 1.449, CI = 1.038-2.204, P = 0.029) or cancer-specific survival (HR = 1.876, CI = 1.415-2.489, P < 0.001; HR = 1.701, CI = 1.168-2.478, P = 0.006). After we performed propensity score weighting and integrated the weights for each covariate in the multivariate cox proportional model. BCS+RT remained to be prognostic beneficial compared to the other treatment options (P < 0.001). ConclusionBCS+RT demonstrated better prognosis than MRM only and MRM+RT treatments for early-staged TNBC patients.

    Citation: Shuoer Wang, Yidi Sun, Songjiao Zhao, Feng Wei, Gong Yang. Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients[J]. Mathematical Biosciences and Engineering, 2020, 17(1): 92-104. doi: 10.3934/mbe.2020005

    Related Papers:

  • BackgroundTriple-negative breast cancer (TNBC) is a subtype of breast cancer with stronger invasive capacity. For the operation strategies of early staged (stage Ⅰ and stage Ⅱ) TNBC patients, BCS plus radiotherapy (BCS+RT), mastectomy only (MRM only) or MRM plus radiotherapy (MRM+RT) is feasible, but no clear conclusion has been made on the choice of these treatments. MethodsThe early staged TNBC patients (stage Ⅰ and stage Ⅱ) from the Surveillance, Epidemiology and End Results (SEER) program database between 1973 and 2014 were included in the study. Survival curves, univariate and multivariate cox proportional hazards models and propensity score weighting were applied to evaluate the prognostic impact among BCS+RT, MRM only and MRM+RT for patients. ResultsBoth overall and cancer-specific survival analysis showed that BCS+RT had better prognostic effect than MRM and MRM+RT in the cohort of early-staged triple-negative breast cancer patients (overall survival, P < 0.001; cancer-specific survival, P < 0.001). By taking all the risk factors into a multivariate cox proportional model, MRM and MRM+RT remained to have detrimental effect on the prognosis compared with BCS+RT as shown by either overall (HR = 1.742, CI = 1.387-2.188, P < 0.001; HR = 1.449, CI = 1.038-2.204, P = 0.029) or cancer-specific survival (HR = 1.876, CI = 1.415-2.489, P < 0.001; HR = 1.701, CI = 1.168-2.478, P = 0.006). After we performed propensity score weighting and integrated the weights for each covariate in the multivariate cox proportional model. BCS+RT remained to be prognostic beneficial compared to the other treatment options (P < 0.001). ConclusionBCS+RT demonstrated better prognosis than MRM only and MRM+RT treatments for early-staged TNBC patients.


    加载中


    [1] R. L. Siegel, K. D. Miller and A. Jemal, Cancer statistics, 2017, Ca-Cancer J. Clin., 67 (2017), 7-30.
    [2] R. Ismail-Khan and M. M. Bui, A review of triple-negative breast cancer, Cancer Control: J. Moffitt Cancer Center, 17 (2010), 173-176.
    [3] P. Boyle, Triple-negative breast cancer: Epidemiological considerations and recommendations, Ann. Oncol.: Off. J. Eur. Soc. Med. Oncol., 23 (2012), 7-12.
    [4] N. U. Lin, A. Vanderplas, M. E. Hughes, et al, Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network, Cancer, 118 (2012), 5463-5472.
    [5] X. Chen, F. Xia, J. Luo, 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, OncoTargets Ther., 11 (2018), 1973-1980.
    [6] R. W. Carlson, D. C. Allred, B. O. Anderson, et al, Breast cancer. Clinical practice guidelines in oncology, J. Nat. Compr. Cancer Network: JNCCN, 7 (2009), 122-192.
    [7] W. Gradishar, K. E. Salerno, NCCN guidelines update: Breast cancer, J. Natl. Compr. Cancer Network, 14 (2016), 641-644.
    [8] U. Veronesi, N. Cascinelli, L. Mariani, et al., Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer, New Eng. J. Med., 347 (2002), 1227-1232.
    [9] B. S. Abdulkarim, J. Cuartero, J. Hanson, et al., 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.: Off. J. Am. Soc. Clin. Oncol., 29 (2011), 2852-2858.
    [10] F. C. Adkins, A. M. Gonzalez-Angulo, X. Lei, et al, Triple-negative breast cancer is not a contraindication for breast conservation, Ann. Surg. Oncol., 18 (2011), 3164-3173.
    [11] M. C. van Maaren, L. de Munck, G. H. de Bock, et al., 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: A population-based study, Lancet Oncol., 17 (2016), 1158-1170.
    [12] X. Chen, X. Yu, J. Chen, et al., Analysis in early stage triple-negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors, Cancer, 119 (2013), 2366-2374.
    [13] Q. X. Chen, X. X. Wang, P. Y. Lin, et al., The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer: A population-based study from the SEER 18 database, Oncotarget, 8 (2017), 4773-4780. doi: 10.18632/oncotarget.13976
    [14] J. K. Horton, R. Jagsi, W. A. Woodward, et al., Breast cancer biology: Clinical implications for breast radiation therapy, Int. J. Radiat. Oncol., Biol., Phys., 100 (2018), 23-37.
    [15] R. C. Brianese, K. D. M. Nakamura, F. Almeida, et al, BRCA1 deficiency is a recurrent event in early-onset triple-negative breast cancer: A comprehensive analysis of germline mutations and somatic promoter methylation, Breast Cancer Res. Treatment., 167 (2018), 803-814.
    [16] S. Y. Phuah, L. M. Looi, N. Hassan, et al., Triple-negative breast cancer and PTEN (phosphatase and tensin homologue) loss are predictors of BRCA1 germline mutations in women with early-onset and familial breast cancer, but not in women with isolated late-onset breast cancer, Breast Cancer Res., 14 (2012), R142.
    [17] M. Kalimutho, K. Parsons, D. Mittal, et al., Targeted therapies for triple-negative breast cancer: Combating a stubborn disease, Trends Pharmacol. Sci., 36 (2015), 822-846. doi: 10.1016/j.tips.2015.08.009
    [18] H. Jia, C. I. Truica, B. Wang, et al., Immunotherapy for triple-negative breast cancer: Existing challenges and exciting prospects, Drug Resist. Updates: Rev. Comment. Antimicrob. Anticancer Chemother., 32 (2017), 1-15.
  • Reader Comments
  • © 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(4374) PDF downloads(826) Cited by(10)

Article outline

Figures and Tables

Figures(1)  /  Tables(4)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog