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Bonci EA, Țîțu Ș, Petrușan AM, Hossu C, Gâta VA, Ghomi MT, Kubelac PM, Bonci TI, Piciu A, Cosnarovici M, Hîțu L, Kirsch-Mangu AT, Pop DC, Lisencu IC, Achimaș-Cadariu P, Piciu D, Schmidt H, Fetica B. Does Surgical Margin Width Remain a Challenge for Triple-Negative Breast Cancer? A Retrospective Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57030203. [PMID: 33652670 PMCID: PMC7996718 DOI: 10.3390/medicina57030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0-5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23-126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe "no ink on tumor" approach for TNBC patients treated with BCS.
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Affiliation(s)
- Eduard-Alexandru Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Ștefan Țîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Alexandru Marius Petrușan
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Claudiu Hossu
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Vlad Alexandru Gâta
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Morvarid Talaeian Ghomi
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Paul Milan Kubelac
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
- Correspondence: (P.M.K.); (I.C.L.)
| | - Teodora Irina Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Andra Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Maria Cosnarovici
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Liviu Hîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Alexandra Timea Kirsch-Mangu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Diana Cristina Pop
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Ioan Cosmin Lisencu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
- Correspondence: (P.M.K.); (I.C.L.)
| | - Patriciu Achimaș-Cadariu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Doina Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Nuclear Medicine, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Hank Schmidt
- Division of Breast Surgery, Tisch Cancer Institute, Mount Sinai Health System, New York, NY 10029, USA;
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bogdan Fetica
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Anatomical Pathology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
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Risk stratification for prediction of locoregional recurrence in patients with pathologic T1-2N0 breast cancer after mastectomy. BMC Cancer 2020; 20:1132. [PMID: 33228588 PMCID: PMC7685539 DOI: 10.1186/s12885-020-07594-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background Previous studies have revealed that nearly 15–20% of selected high-risk T1–2N0 breast cancers developed LRR after mastectomy. This study is aim to indentify the risk factors of locoregional recurrence (LRR) in patients with pathologic T1–2N0 breast cancer after mastectomy in a real-world and distinguish individuals who warrant postmastectomy radiotherapy (PMRT). Methods Female patients treated from 1999 to 2014 in National Cancer Center of China were retrospectively reviewed. A competing risk model was developed to estimate the cumulative incidence of LRR with death treated as a competing event. Results A total of 4841 patients were eligible. All underwent mastectomy plus axillary nodes dissection or sentinel node biopsy without PMRT. With a median follow-up of 56.4 months (range, 1–222 months), the 5-year LRR rate was 3.9%.Besides treatment era, age ≤ 40 years old (p < 0.001, hazard ratio [HR] = 2.262), tumor located in inner quadrant (p < 0.001, HR = 2.236), T2 stage (p = 0.020, HR = 1.419), and negative expressions of estrogen receptor (ER) and progesterone receptor (PR) (p = 0.032, HR = 1.485), were patients-related independent risk factors for LRR. The 5-year LRR rates were 1.7, 3.5, and 15.0% for patients with zero, 1–2, and 3–4 risk factors (p < 0.001). Conclusions Risk Stratification based on age, T stage, ER/PR status and tumor location can stratify patients with pT1–2 N0 breast cancer into subgroups with different risk of LRR. PMRT might be suggested for patients with 3–4 risk factors.
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O'Rorke MA, Murray LJ, Brand JS, Bhoo-Pathy N. The value of adjuvant radiotherapy on survival and recurrence in triple-negative breast cancer: A systematic review and meta-analysis of 5507 patients. Cancer Treat Rev 2016; 47:12-21. [PMID: 27214603 DOI: 10.1016/j.ctrv.2016.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The value of adjuvant radiotherapy in triple negative breast cancer (TNBC) remains unclear. A systematic review and meta-analysis was conducted in TNBC patients to assess survival and recurrence outcomes associated with radiotherapy following either breast conserving therapy (BCT) or post-mastectomy radiotherapy (PMRT). METHODS Four electronic databases were searched from January 2000 to November 2015 (PubMed, MEDLINE, EMBASE and Web of Science). Studies investigating overall survival and/or recurrence in TNBC patients according to radiotherapy administration were included. A random effects meta-analysis was conducted using mastectomy only patients as the reference. RESULTS Twelve studies were included. The pooled hazard ratio (HR) for locoregional recurrence comparing BCT and PMRT to mastectomy only was 0.61 (95% confidence interval [CI] 0.41-0.90) and 0.62 (95% CI 0.44-0.86), respectively. Adjuvant radiotherapy was not significantly associated with distant recurrence. The pooled HR for overall survival comparing BCT and PMRT to mastectomy only was 0.57 (95% CI 0.36-0.88) and HR 1.12 (95% CI 0.75, 1.69). Comparing PMRT to mastectomy only, tests for interaction were not significant for stage (p=0.98) or age at diagnosis (p=0.85). However, overall survival was improved in patients with late-stage disease (T3-4, N2-3) pooled HR 0.53 (95% CI 0.32-0.86), and women <40years, pooled HR 0.30 (95% CI 0.11-0.82). CONCLUSIONS Adjuvant radiotherapy was associated with a significantly lower risk of locoregional recurrence in TNBC patients, irrespective of the type of surgery. While radiotherapy was not consistently associated with an overall survival gain, benefits may be obtained in women with late-stage disease and younger patients.
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Affiliation(s)
- M A O'Rorke
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Grosvenor Road, Belfast BT12 6BJ, United Kingdom.
| | - L J Murray
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Grosvenor Road, Belfast BT12 6BJ, United Kingdom
| | - J S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden
| | - N Bhoo-Pathy
- Julius Centre University of Malaya (JCUM), Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
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Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review. Clin Breast Cancer 2015. [PMID: 26198331 DOI: 10.1016/j.clbc.2015.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.
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