Delay in initiating postmastectomy radiotherapy is associated with inferiorsurvival outcomes for locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomy
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences ( CAMS ) and Peking Union Medical College ( PUMC),Beijing 100021,China; 2Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China; 3Department of Radiation Oncology,Xijing Hospital,The Fourth Military Medical University,Xi'an 710032,China; 4Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China; 5Department of Oncology,Xiangya Hospital,Central South University,Changsha 410008,China; 6Cancer Center,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430023,China; 7Department of Radiation Oncology,Forth Hospital of Hebei Medical University,Shijiazhuang 050011,China; 8Department of Radiation Oncology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China; 9Department of Radiation Oncology,Cancer Hospital of Jilin Province,Changchun 130012,China; 10Department of Radiation Oncology,First Hospital,Jilin University,Changchun 130021,China; 11Department of Radiation Oncology,First Hospital of Qiqihaer,Qiqihaer 161005,China
Abstract：Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage cⅡ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy. Methods Clinical data of 1087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed. The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method. The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM). Results The median follow-up time was 72.9 months. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1% and 81.8%. All patients were divided into SRI≤18 weeks (n=917) and SRI>18 weeks groups (n=170). Multivariate Cox regression analysis demonstrated that hormone receptor status (P<0.001), pathological T stage (P<0.001), pathological N stage (P<0.001) and SRI (P=0.023) were independent influencing factors of DFS. Hormone receptor status (P=0.013), pathological T stage (P=0.006), pathological N stage (P<0.001), endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS. After balancing the clinical and pathological factors with PSM, patients with SRI< 18 weeks had superior DFS and OS to those with SRI> 18 weeks. Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy. Radiotherapy should be performed within 18 weeks after mastectomy.
Huang Zhou,Wang Shulian,Tang Yu et al. Delay in initiating postmastectomy radiotherapy is associated with inferiorsurvival outcomes for locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomy[J]. Chinese Journal of Radiation Oncology, 2019, 28(4): 280-285.
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2019, Vol. 28 
