Xu-Ran Zhao1, Yu Tang2, Hong-Fen Wu3, Qi-Shuai Guo4, Yu-Jing Zhang5, Mei Shi6, Jing Cheng7, Hong-Mei Wang8, Min Liu9, Chang-Ying Ma10, Ge Wen11, Xiao-Hu Wang12, Hui Fang2, Hao Jing2, Yong-Wen Song2, Jing Jin2, Yue-Ping Liu2, Bo Chen2, Shu-Nan Qi2, Ning Li2, Yuan Tang2, Ning-Ning Lu2, Na Zhang13, Ye-Xiong Li14, Shu-Lian Wang15. 1. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. Electronic address: 923791362@qq.com. 2. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. 3. Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China. 4. Department of Radiation Oncology, Affiliated Cancer Hospital of Chongqing University, Chongqing, China. 5. Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China. 6. Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. 7. Department of Breast Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 8. Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 9. Department of Radiation Oncology, First Hospital of Jilin University, Changchun, China. 10. Department of Radiation Oncology, First Hospital of Qiqihaer, Qiqihaer, China. 11. Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China; Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 12. Department of Radiation Oncology, Gansu Cancer Hospital, Lanzhou, China. 13. Department of Radiation Oncology, Liaoning Cancer Hospital, Shenyang, China. Electronic address: zhangna@cancerhosp-ln-cmu.com. 14. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. Electronic address: yexiong12@163.com. 15. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. Electronic address: wangsl@cicams.ac.cn.
Abstract
PURPOSE: To assess the influence of age as a continuous variable on the prognosis of pT1-2N1 breast cancer and examine its decision-making value for postmastectomy radiotherapy (PMRT). METHODS: We retrospectively evaluated 5438 patients with pT1-2N1 breast cancer after mastectomy in 11 hospitals. A multivariable Cox proportional hazards regression model with penalized splines was used to examine the relationship between age and oncologic outcomes. RESULTS: The median follow-up was 67.0 months. After adjustments for confounding characteristics, nonsignificant downward trend in locoregional recurrence (LRR) risk was observed with increasing age (P-non-linear association = 0.640; P-linear association = 0.078). A significant non-linear association was found between age and disease-free survival (DFS) and overall survival (OS) (P-non-linear association <0.05; P-linear association >0.05, respectively). The DFS and OS exhibited U-shaped relationships, with the hazard ratios (HRs), reaching a nadir at 50 years old. A decreased risk of LRR with PMRT vs. no PMRT (HR = 0.304, 95% CI: 0.204-0.454) was maintained in all ages. The HR of PMRT vs. no PMRT for DFS and OS gradually increased with age. In patients ≤50 years old, PMRT was independently associated with favorable LRR, DFS, and OS, all P < 0.05). In patients >50 years old, PMRT was independently associated with reduced LRR (P = 0.004), but had no effect on DFS or OS. CONCLUSIONS: Age was an independent prognostic factor for pT1-2N1 breast cancer; PMRT provided survival benefits for patients ≤50 years old, but not for patients >50 years old.
PURPOSE: To assess the influence of age as a continuous variable on the prognosis of pT1-2N1 breast cancer and examine its decision-making value for postmastectomy radiotherapy (PMRT). METHODS: We retrospectively evaluated 5438 patients with pT1-2N1 breast cancer after mastectomy in 11 hospitals. A multivariable Cox proportional hazards regression model with penalized splines was used to examine the relationship between age and oncologic outcomes. RESULTS: The median follow-up was 67.0 months. After adjustments for confounding characteristics, nonsignificant downward trend in locoregional recurrence (LRR) risk was observed with increasing age (P-non-linear association = 0.640; P-linear association = 0.078). A significant non-linear association was found between age and disease-free survival (DFS) and overall survival (OS) (P-non-linear association <0.05; P-linear association >0.05, respectively). The DFS and OS exhibited U-shaped relationships, with the hazard ratios (HRs), reaching a nadir at 50 years old. A decreased risk of LRR with PMRT vs. no PMRT (HR = 0.304, 95% CI: 0.204-0.454) was maintained in all ages. The HR of PMRT vs. no PMRT for DFS and OS gradually increased with age. In patients ≤50 years old, PMRT was independently associated with favorable LRR, DFS, and OS, all P < 0.05). In patients >50 years old, PMRT was independently associated with reduced LRR (P = 0.004), but had no effect on DFS or OS. CONCLUSIONS: Age was an independent prognostic factor for pT1-2N1 breast cancer; PMRT provided survival benefits for patients ≤50 years old, but not for patients >50 years old.
Authors: Mila Donker; Geertjan van Tienhoven; Marieke E Straver; Philip Meijnen; Cornelis J H van de Velde; Robert E Mansel; Luigi Cataliotti; A Helen Westenberg; Jean H G Klinkenbijl; Lorenzo Orzalesi; Willem H Bouma; Huub C J van der Mijle; Grard A P Nieuwenhuijzen; Sanne C Veltkamp; Leen Slaets; Nicole J Duez; Peter W de Graaf; Thijs van Dalen; Andreas Marinelli; Herman Rijna; Marko Snoj; Nigel J Bundred; Jos W S Merkus; Yazid Belkacemi; Patrick Petignat; Dominic A X Schinagl; Corneel Coens; Carlo G M Messina; Jan Bogaerts; Emiel J T Rutgers Journal: Lancet Oncol Date: 2014-10-15 Impact factor: 41.316
Authors: Lior Z Braunstein; Alphonse G Taghian; Andrzej Niemierko; Laura Salama; Alexander Capuco; Jennifer R Bellon; Julia S Wong; Rinaa S Punglia; Shannon M MacDonald; Jay R Harris Journal: Breast Cancer Res Treat Date: 2016-11-03 Impact factor: 4.872
Authors: P McGale; C Taylor; C Correa; D Cutter; F Duane; M Ewertz; R Gray; G Mannu; R Peto; T Whelan; Y Wang; Z Wang; S Darby Journal: Lancet Date: 2014-03-19 Impact factor: 79.321