51. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database
- Author
-
Tara M. Breslin, Rachel C. Blitzblau, Yolanda D. Tseng, Michael J. Hassett, Richard L. Theriault, Stephen B. Edge, Melissa E. Hughes, Yu-Ning Wong, Beverly Moy, Hajime Uno, Joyce C. Niland, and Rinaa S. Punglia
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Receptor, ErbB-2 ,medicine.medical_treatment ,Antineoplastic Agents ,Breast Neoplasms ,Triple Negative Breast Neoplasms ,Risk Assessment ,Trastuzumab ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intermediate Grade ,Propensity Score ,skin and connective tissue diseases ,Mastectomy ,Gynecology ,Radiation ,business.industry ,Hazard ratio ,Middle Aged ,Radiation therapy ,Receptors, Estrogen ,Propensity score matching ,Female ,Neoplasm Recurrence, Local ,Receptors, Progesterone ,business ,Breast carcinoma ,Follow-Up Studies ,medicine.drug - Abstract
Purpose To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype. Methods and Materials Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2−, low/intermediate grade), luminal B (ER/PR+, HER2−, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER−, PR−, HER2−). LRR hazard ratios (HR) were estimated with multivariable Fine and Gray models. The effect of PMRT on LRR was evaluated with Fine and Gray models stratified by propensity for PMRT. Results With a median follow-up time of 50.1 months, there were 19 iLRR and 109 LRR events. HER2 patients with trastuzumab had no iLRR and only a single LRR. Compared with luminal A patients, TN patients had significantly greater adjusted risk of iLRR (HR 14.10; 95% CI 2.97%-66.90%), with a similar trend among luminal B (HR 4.94; 95% CI 0.94%-25.82%) and HER2 patients without trastuzumab (HR 4.41; 95% CI 0.61%-32.11%). Although PMRT reduced LRR, the effect of PMRT varied by subgroup, with the greatest and smallest effects seen among luminal A (HR 0.17; 95% CI 0.05%-0.62%) and TN patients (HR 0.59; 95% CI 0.25%-1.35%), respectively. Conclusions TN patients had the highest risk of LRR and the least benefit from PMRT; these patients may benefit from alternative treatment strategies. In contrast, in the era of HER2-directed therapy, the role of local therapy may need to be reassessed among HER2 patients.
- Published
- 2015