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Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram
Introduction We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer. Methods Patients aged 65 years and older with T1–2N0–1, hormone receptor-negative breast cancer in 2010–2015...
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| Published in: | Advances in therapy 2022-10, Vol.39 (10), p.4707-4722 |
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| container_issue | 10 |
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| container_title | Advances in therapy |
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| creator | Xu, Li Zhou, Chen Qiu, Juanjuan Lv, Qing Du, Zhenggui |
| description | Introduction
We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer.
Methods
Patients aged 65 years and older with T1–2N0–1, hormone receptor-negative breast cancer in 2010–2015 were extracted from the Surveillance, Epidemiology, and End Results program. Propensity score matching was used to balance the baseline of different groups. Survival analysis was performed using Kaplan–Meier plot and log-rank test. Independent risk factors were identified by multivariate Cox analysis. A nomogram predicting breast cancer-specific survival (BCSS) and a risk stratification model were constructed and validated.
Results
A total of 4465 patients were included and 27.7% (1237/4465) patients did not receive postoperative RT. RT was significantly associated with improved overall survival (OS) (HR = 0.552
P
|
| doi_str_mv | 10.1007/s12325-022-02279-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2702192913</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2702192913</sourcerecordid><originalsourceid>FETCH-LOGICAL-c228t-e3d30a8cb8c782fb206496bafc33b0948741be3115c8ef4aeec6c4a950012b743</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EotvCH-CAfOSAwR_5cE5ou1ooUtWuuiBxsxxnkqZK7GA7Rflp_Xd42YUjh9FIM--8Y8-D0BtGPzBKy4-BccFzQjk_RFmR5RlaMVnkJAV_jla0zBjhQv44Q-chPFDKaZnLl-hM5FUuiiJfoaeNtvhON72L9-D1tOB1G8HjSw86RLJxNoB_7G2H97PvwC-4Bnw79jFCg3uLt0MDfljwTscebAz4Vx_v8VanGtlH3cF7fOX86CyQOzAwRefxDXRJ_QinJTg9wYD_hNd456Z5SD1nyaUOacM-zs2CtW3wzrvJHUo3bnSd1-Mr9KLVQ4DXp3yBvn_efttckevbL18362tiOJeRgGgE1dLU0pSStzWnRVYVtW6NEDWtMpluVINgLDcS2kwDmMJkusopZbwuM3GB3h19J-9-zhCiGvtgYBi0BTcHxUvKWcUrJpKUH6XGuxA8tGry_aj9ohhVB2TqiEwlXOoPMrWkobcn_7keofk38pdREoijIKSWTQzUg5u9TX_-n-1vfW6lew</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2702192913</pqid></control><display><type>article</type><title>Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram</title><source>Springer Link</source><source>Alma/SFX Local Collection</source><creator>Xu, Li ; Zhou, Chen ; Qiu, Juanjuan ; Lv, Qing ; Du, Zhenggui</creator><creatorcontrib>Xu, Li ; Zhou, Chen ; Qiu, Juanjuan ; Lv, Qing ; Du, Zhenggui</creatorcontrib><description>Introduction
We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer.
Methods
Patients aged 65 years and older with T1–2N0–1, hormone receptor-negative breast cancer in 2010–2015 were extracted from the Surveillance, Epidemiology, and End Results program. Propensity score matching was used to balance the baseline of different groups. Survival analysis was performed using Kaplan–Meier plot and log-rank test. Independent risk factors were identified by multivariate Cox analysis. A nomogram predicting breast cancer-specific survival (BCSS) and a risk stratification model were constructed and validated.
Results
A total of 4465 patients were included and 27.7% (1237/4465) patients did not receive postoperative RT. RT was significantly associated with improved overall survival (OS) (HR = 0.552
P
< 0.001) and BCSS (HR = 0.559,
P
< 0.001) in the matched cohort. The same results were found after adjusting independent risk factors by multivariate analysis. On the basis of the nomogram predicting BCSS of patients without RT by incorporating independent risk factors (age, race, HER2 status, T stage, and N stage), we built a risk stratification model which indicated that RT improved OS (HR = 0.511,
P
< 0.001) and BCSS (HR = 0.517,
P
< 0.001) in the high-risk group (total score > 150), but not in the low-risk group (total score ≤ 120). The C-index and all calibration curves demonstrated sufficient accuracies and good predictive capabilities.
Conclusions
RT is indeed beneficial for the whole cohort in this study. However, it may be omitted in the low-risk subgroup without significantly sacrificing survival. For patients in the high-risk group, RT following BCS remained beneficial. This study highlights the need for prospective randomized trials to study RT de-escalation strategies.</description><identifier>ISSN: 0741-238X</identifier><identifier>EISSN: 1865-8652</identifier><identifier>DOI: 10.1007/s12325-022-02279-y</identifier><identifier>PMID: 35953665</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Aged ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Cardiology ; Endocrinology ; Female ; Hormones ; Humans ; Internal Medicine ; Mastectomy, Segmental - methods ; Medicine ; Medicine & Public Health ; Neoplasm Staging ; Nomograms ; Oncology ; Original Research ; Pharmacology/Toxicology ; Prospective Studies ; Rheumatology ; SEER Program ; Triple Negative Breast Neoplasms</subject><ispartof>Advances in therapy, 2022-10, Vol.39 (10), p.4707-4722</ispartof><rights>The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c228t-e3d30a8cb8c782fb206496bafc33b0948741be3115c8ef4aeec6c4a950012b743</cites><orcidid>0000-0002-7412-0270</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35953665$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xu, Li</creatorcontrib><creatorcontrib>Zhou, Chen</creatorcontrib><creatorcontrib>Qiu, Juanjuan</creatorcontrib><creatorcontrib>Lv, Qing</creatorcontrib><creatorcontrib>Du, Zhenggui</creatorcontrib><title>Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram</title><title>Advances in therapy</title><addtitle>Adv Ther</addtitle><addtitle>Adv Ther</addtitle><description>Introduction
We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer.
Methods
Patients aged 65 years and older with T1–2N0–1, hormone receptor-negative breast cancer in 2010–2015 were extracted from the Surveillance, Epidemiology, and End Results program. Propensity score matching was used to balance the baseline of different groups. Survival analysis was performed using Kaplan–Meier plot and log-rank test. Independent risk factors were identified by multivariate Cox analysis. A nomogram predicting breast cancer-specific survival (BCSS) and a risk stratification model were constructed and validated.
Results
A total of 4465 patients were included and 27.7% (1237/4465) patients did not receive postoperative RT. RT was significantly associated with improved overall survival (OS) (HR = 0.552
P
< 0.001) and BCSS (HR = 0.559,
P
< 0.001) in the matched cohort. The same results were found after adjusting independent risk factors by multivariate analysis. On the basis of the nomogram predicting BCSS of patients without RT by incorporating independent risk factors (age, race, HER2 status, T stage, and N stage), we built a risk stratification model which indicated that RT improved OS (HR = 0.511,
P
< 0.001) and BCSS (HR = 0.517,
P
< 0.001) in the high-risk group (total score > 150), but not in the low-risk group (total score ≤ 120). The C-index and all calibration curves demonstrated sufficient accuracies and good predictive capabilities.
Conclusions
RT is indeed beneficial for the whole cohort in this study. However, it may be omitted in the low-risk subgroup without significantly sacrificing survival. For patients in the high-risk group, RT following BCS remained beneficial. This study highlights the need for prospective randomized trials to study RT de-escalation strategies.</description><subject>Aged</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Cardiology</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Hormones</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Mastectomy, Segmental - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Staging</subject><subject>Nomograms</subject><subject>Oncology</subject><subject>Original Research</subject><subject>Pharmacology/Toxicology</subject><subject>Prospective Studies</subject><subject>Rheumatology</subject><subject>SEER Program</subject><subject>Triple Negative Breast Neoplasms</subject><issn>0741-238X</issn><issn>1865-8652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi0EotvCH-CAfOSAwR_5cE5ou1ooUtWuuiBxsxxnkqZK7GA7Rflp_Xd42YUjh9FIM--8Y8-D0BtGPzBKy4-BccFzQjk_RFmR5RlaMVnkJAV_jla0zBjhQv44Q-chPFDKaZnLl-hM5FUuiiJfoaeNtvhON72L9-D1tOB1G8HjSw86RLJxNoB_7G2H97PvwC-4Bnw79jFCg3uLt0MDfljwTscebAz4Vx_v8VanGtlH3cF7fOX86CyQOzAwRefxDXRJ_QinJTg9wYD_hNd456Z5SD1nyaUOacM-zs2CtW3wzrvJHUo3bnSd1-Mr9KLVQ4DXp3yBvn_efttckevbL18362tiOJeRgGgE1dLU0pSStzWnRVYVtW6NEDWtMpluVINgLDcS2kwDmMJkusopZbwuM3GB3h19J-9-zhCiGvtgYBi0BTcHxUvKWcUrJpKUH6XGuxA8tGry_aj9ohhVB2TqiEwlXOoPMrWkobcn_7keofk38pdREoijIKSWTQzUg5u9TX_-n-1vfW6lew</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Xu, Li</creator><creator>Zhou, Chen</creator><creator>Qiu, Juanjuan</creator><creator>Lv, Qing</creator><creator>Du, Zhenggui</creator><general>Springer Healthcare</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7412-0270</orcidid></search><sort><creationdate>202210</creationdate><title>Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram</title><author>Xu, Li ; Zhou, Chen ; Qiu, Juanjuan ; Lv, Qing ; Du, Zhenggui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c228t-e3d30a8cb8c782fb206496bafc33b0948741be3115c8ef4aeec6c4a950012b743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Cardiology</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Hormones</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Mastectomy, Segmental - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Staging</topic><topic>Nomograms</topic><topic>Oncology</topic><topic>Original Research</topic><topic>Pharmacology/Toxicology</topic><topic>Prospective Studies</topic><topic>Rheumatology</topic><topic>SEER Program</topic><topic>Triple Negative Breast Neoplasms</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xu, Li</creatorcontrib><creatorcontrib>Zhou, Chen</creatorcontrib><creatorcontrib>Qiu, Juanjuan</creatorcontrib><creatorcontrib>Lv, Qing</creatorcontrib><creatorcontrib>Du, Zhenggui</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Advances in therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xu, Li</au><au>Zhou, Chen</au><au>Qiu, Juanjuan</au><au>Lv, Qing</au><au>Du, Zhenggui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram</atitle><jtitle>Advances in therapy</jtitle><stitle>Adv Ther</stitle><addtitle>Adv Ther</addtitle><date>2022-10</date><risdate>2022</risdate><volume>39</volume><issue>10</issue><spage>4707</spage><epage>4722</epage><pages>4707-4722</pages><issn>0741-238X</issn><eissn>1865-8652</eissn><abstract>Introduction
We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer.
Methods
Patients aged 65 years and older with T1–2N0–1, hormone receptor-negative breast cancer in 2010–2015 were extracted from the Surveillance, Epidemiology, and End Results program. Propensity score matching was used to balance the baseline of different groups. Survival analysis was performed using Kaplan–Meier plot and log-rank test. Independent risk factors were identified by multivariate Cox analysis. A nomogram predicting breast cancer-specific survival (BCSS) and a risk stratification model were constructed and validated.
Results
A total of 4465 patients were included and 27.7% (1237/4465) patients did not receive postoperative RT. RT was significantly associated with improved overall survival (OS) (HR = 0.552
P
< 0.001) and BCSS (HR = 0.559,
P
< 0.001) in the matched cohort. The same results were found after adjusting independent risk factors by multivariate analysis. On the basis of the nomogram predicting BCSS of patients without RT by incorporating independent risk factors (age, race, HER2 status, T stage, and N stage), we built a risk stratification model which indicated that RT improved OS (HR = 0.511,
P
< 0.001) and BCSS (HR = 0.517,
P
< 0.001) in the high-risk group (total score > 150), but not in the low-risk group (total score ≤ 120). The C-index and all calibration curves demonstrated sufficient accuracies and good predictive capabilities.
Conclusions
RT is indeed beneficial for the whole cohort in this study. However, it may be omitted in the low-risk subgroup without significantly sacrificing survival. For patients in the high-risk group, RT following BCS remained beneficial. This study highlights the need for prospective randomized trials to study RT de-escalation strategies.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>35953665</pmid><doi>10.1007/s12325-022-02279-y</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-7412-0270</orcidid></addata></record> |
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| subjects | Aged Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Cardiology Endocrinology Female Hormones Humans Internal Medicine Mastectomy, Segmental - methods Medicine Medicine & Public Health Neoplasm Staging Nomograms Oncology Original Research Pharmacology/Toxicology Prospective Studies Rheumatology SEER Program Triple Negative Breast Neoplasms |
| title | Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram |
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