*Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in Southern China,Guangzhou 510060,ChinaCorresponding authors:Zhang Yujing,Email:zhangyj@sysucc.org.cn;Wen Bixiu,Department of Radiation Oncology,First Affiliated Hospital of Sun yat-sen University,Guangzhou 510080,China;Email:wenbix@mail.sysu.edu.cn
Abstract：Objective To explore the predictive value of primary tumor site for loco-regional recurrence (LRR) in early breast cancer patients with one to three positive axillary lymph nodes after radical surgery. Methods The clinical data of 656 patients pathologically diagnosed with pT1-2N1M0 breast cancer who received radical surgery without postoperative radiotherapy in our hospital from 1998 to 2010 were retrospectively analyzed. In those patients, 156 had primary tumor located in the inner quadrant, 45 in the central quadrant, and 455 in the outer quadrant. LRR and local recurrence-free survival (LRFS) were end points. The Kaplan-Meier method was used to estimate LRR and LRFS rates. The log-rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate analysis was performed using the Cox regression model. Results The 5-and 10-year sample sizes were 416 and 191, respectively. The 5-and 10-year LRR rates were 8.6% and 12.9%, respectively, while the 5-and 10-year LRFS rates were 86.2% and 76.4%, respectively. The univariate analysis indicated that age, pT stage, Ki67 level, molecular classification, and primary tumor in the inner quadrant were significant influencing factors for LRR (P=0.000,0.006,0.017,0.004,0.000). The multivariate analysis showed that age no greater than 35 years, primary tumor in the inner quadrant, and non-luminal subtype in molecular classification were independent prognostic factors for LRR and LRFS (P=0.0012,0.012,0.005). With an increasing number of risk factors(≥2), patients with primary tumor in the inner quadrant had a dramatically increased LRR rate and a reduced LRFS rate, while patients with primary tumor in the outer or central quadrant kept the same LRR and LRFS rates. Conclusions The primary tumor site holds promise for prediction of LRR and LRFS in patients with pT1-2N1M0 breast cancer after radical surgery. Patients with primary tumor located in the inner quadrant have a high LRR rate and a low LRFS rate, which provides an excellent predictor for the risk of recurrence in patients with high-risk breast cancer.
Niu Shaoqing*,Wen Ge,Zhang Yujing et al. Prognostic value of primary tumor site in early breast cancer patients with one to three positive axillary lymph nodes after radical surgery[J]. Chinese Journal of Radiation Oncology, 2015, 24(5): 506-510.
[1] Ragaz J,Olivotto IA,Spinelli JJ,et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy:20-year results of the British Columbia randomized trial[J].J Natl Cancer Inst,2005,97(2):116-126.DOI:10.1093/jnci/djh297. [2] Katz A,Strom EA,Buchholz TA,et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy:implications for postoperative irradiation[J].J Clin Oncol,2000,18(15):2817-2827. [3] Woodward WA,Strom EA,Tucker SL,et al. Locoregional recurrence after doxorubicin-based chemotherapy and postmastectomy:Implications for breast cancer patients with early-stage disease and predictors for recurrence after postmastectomy radiation[J].Int J Radiat Oncol Biol Phys,2003,57(2):336-344.DOI:10.1016/S0360-3016(03)00593-5. [4] Buchholz TA,Woodward WA,Duan ZG,et al. Radiation use and long-term survival in breast cancer patients with T1,T2 primary tumors and one to three positive axillary lymph nodes[J].Int J Radiat Oncol Biol Phys,2008,71(4):1022-1027.DOI:10.1016/j.ijrobp.2007.11.036. [5] 温戈,张玉晶,祝喻甲,等.分子分型对1~3个腋窝淋巴结转移早期乳腺癌患者局部或区域复发风险的预测价值[J].中华放射肿瘤学杂志,2013,22(2):89-93.DOI:10.3760/cma.j.issn.1004-4221.2013.02.001. [6] 《乳腺癌HER-2 检测指南》编写组.乳腺癌HER-2 检测指南[J].中华病理学杂志,2006,35(10):631-633. [7] 王淑莲,李晔雄,宋永文,等.激素受体和人表皮生长因子受体2的表达与改良根治术后淋巴结阳性乳腺癌患者预后的关系[J].中华肿瘤杂志,2010,32(7):520-525.DOI:10.3760/cma.j.issn.0253-3766.2010.07.010. [8] Overgaard M,Nielsen HM,Overgaard J.Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes,as recommended in international consensus reports？ A subgroup analysis of the DBCG 82 b&c randomized trials[J].Radiother Oncol,2007,82(3):247-253.DOI:10.1016/j.radonc.2007.02.001. [9] Whelan TJ,Olivotto I,Ackerman I,et al. NCIC-CTG MA.20:an intergroup trial of regional nodal irradiation in early breast cancer[J].J Clin Oncol,2011,29(18 Supll):LBA1003. [10] 周卫兵,冯炎,陈佳艺,等.术后放疗在伴有腋窝淋巴结1~3个转移的T1~T2期乳腺癌中的作用[J].中华放射肿瘤学杂志,2006,15(5):396-400.DOI:10.3760/j.issn:1004-4221.2006.05.010. [11] Janni W,Rack B,Sommer H,et al. Intra-mammary tumor location does not influence prognosis but influences the prevalence of axillary lymph-node metastases[J].J Cancer Res Clin Oncol,2003,129(9):503-510.DOI:10.1007/s00432-003-0465-3. [12] Jayasinghe UW,Boyages J.Tumour location is not an independent prognostic factor for survival following a diagnosis of breast cancer[J].Breast,2009,18(1):41-46.DOI:10.1016/j.breast.2008.10.004. [13] Gaffney DK,Tsodikov A,Wiggins CL.Diminished survival in patients with inner versus outer quadrant breast cancers[J].J Clin Oncol,2003,21(3):467-472.DOI:10.1200/JCO.2003.12.047. [14] Hazrah P,Dhir M,Gupta SD,et al. Prognostic significance of location of the primary tumor in operable breast cancers[J].Indian J Cancer,2009,46(2):139-145.DOI:10.4103/0019－509X.49152. [15] Colleoni M,Zahrieh D,Gelber RD,et al. Site of primary tumor has a prognostic role in operable breast cancer:the international breast cancer study group experience[J].J Clin Oncol,2005,23(7):1390-1400.DOI:10.1200/JCO.2005.06.052.
2015, Vol. 24 
