Ming Li1, Jinbo Yue2, Xiangbo Wan3, Bin Hua4, Qiuan Yang5, Pei Yang6, Zijian Zhang7, Qian Pei8, Weidong Han9, Yaping Xu10, Xuefeng Xia10. 1. Department of Radiation Oncology, Beijing Hospital/National Center of Gerontology, Beijing, China. 2. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University/Shandong Academy of Medical Sciences, Jinan, China. 3. Department of Radiation Oncology, The Sixth Affiliated Hospital - Sun Yat-sen University, Guangzhou, China. 4. Department of Breast Cancer Surgery, Beijing Hospital/National Center of Gerontology, Beijing, China. 5. Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China. 6. Department of Radiation Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine - Central South University, Changsha, China. 7. Department of Radiation Oncology, Xiangya Hospital - Central South University, Changsha, China. 8. Department of General Surgery, Xiangya Hospital - Central South University, Changsha, China. 9. Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China. 10. Geneplus-Beijing Institute, Beijing, China.
Abstract
PURPOSE: The aim of this study was to develop a widely accepted prognostic nomogram and establish a risk-adapted PMRT strategy based on locoregional recurrence for pT1-2N1M0 breast cancer. METHODS AND MATERIALS: A total of 3,033 patients with pT1-2N1M0 breast cancer treated at 6 participating institutions between 2000 and 2016 were retrospectively reviewed. A nomogram was developed to predicted locoregional recurrence-free survival (LRFS). A propensity score-matched (PSM) analyses was performed in risk-adapted model. RESULTS: With the median follow-up of 65.0 months, the 5-year overall survival (OS), disease free survival (DFS) and LRFS were 93.0, 84.8, and 93.6%, respectively. There was no significant difference between patients who received PMRT or not for the entire group. A nomogram was developed and validated to estimate the probability of 5-year LRFS based on five independent factors including age, primary tumor site, positive lymph nodes number, pathological T stage, and molecular subtype that were selected by a multivariate analysis of patients who did not receive PMRT in the primary cohort. According to the total nomogram risk scores, the entire patients were classified into low- (40.0%), moderate- (42.4%), and high-risk group (17.6%). The 5-year outcomes were significantly different among these three groups (P<0.001). In low-risk group, patients who received PMRT or not both achieved a favorable OS, DFS, and LRFS. In moderate-risk group, no differences in OS, DFS, and LRFS were observed between PMRT and no PMRT patients. In high-risk group, compared with no PMRT, PMRT resulted in significantly different OS (86.8 vs 83.9%, P = 0.050), DFS (77.2 vs 70.9%, P = 0.049), and LRFS (90.8 vs. 81.6%, P = 0.003). After PSM adjustment, there were no significant differences in OS, DFS, and LRFS in low-risk and moderate-risk groups. However, in the high-risk group, PMRT still resulted in significantly better OS, DFS and improved LRFS. CONCLUSIONS: The proposed nomogram provides an individualized risk estimate of LRFS in patients with pT1-2N1M0 breast cancer. Risk-adapted PMRT for high-risk patients is a viable effective strategy.
PURPOSE: The aim of this study was to develop a widely accepted prognostic nomogram and establish a risk-adapted PMRT strategy based on locoregional recurrence for pT1-2N1M0 breast cancer. METHODS AND MATERIALS: A total of 3,033 patients with pT1-2N1M0 breast cancer treated at 6 participating institutions between 2000 and 2016 were retrospectively reviewed. A nomogram was developed to predicted locoregional recurrence-free survival (LRFS). A propensity score-matched (PSM) analyses was performed in risk-adapted model. RESULTS: With the median follow-up of 65.0 months, the 5-year overall survival (OS), disease free survival (DFS) and LRFS were 93.0, 84.8, and 93.6%, respectively. There was no significant difference between patients who received PMRT or not for the entire group. A nomogram was developed and validated to estimate the probability of 5-year LRFS based on five independent factors including age, primary tumor site, positive lymph nodes number, pathological T stage, and molecular subtype that were selected by a multivariate analysis of patients who did not receive PMRT in the primary cohort. According to the total nomogram risk scores, the entire patients were classified into low- (40.0%), moderate- (42.4%), and high-risk group (17.6%). The 5-year outcomes were significantly different among these three groups (P<0.001). In low-risk group, patients who received PMRT or not both achieved a favorable OS, DFS, and LRFS. In moderate-risk group, no differences in OS, DFS, and LRFS were observed between PMRT and no PMRT patients. In high-risk group, compared with no PMRT, PMRT resulted in significantly different OS (86.8 vs 83.9%, P = 0.050), DFS (77.2 vs 70.9%, P = 0.049), and LRFS (90.8 vs. 81.6%, P = 0.003). After PSM adjustment, there were no significant differences in OS, DFS, and LRFS in low-risk and moderate-risk groups. However, in the high-risk group, PMRT still resulted in significantly better OS, DFS and improved LRFS. CONCLUSIONS: The proposed nomogram provides an individualized risk estimate of LRFS in patients with pT1-2N1M0 breast cancer. Risk-adapted PMRT for high-risk patients is a viable effective strategy.
Authors: A Recht; R Gray; N E Davidson; B L Fowble; L J Solin; F J Cummings; G Falkson; H C Falkson; S G Taylor; D C Tormey Journal: J Clin Oncol Date: 1999-06 Impact factor: 44.544
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Authors: Ewan K A Millar; Peter H Graham; Sandra A O'Toole; Catriona M McNeil; Lois Browne; Adrienne L Morey; Sarah Eggleton; Julia Beretov; Constantine Theocharous; Anne Capp; Elias Nasser; John H Kearsley; Geoff Delaney; George Papadatos; Christopher Fox; Robert L Sutherland Journal: J Clin Oncol Date: 2009-08-31 Impact factor: 44.544
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