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Breast-conserving surgery without axillary lymph node surgery or radiotherapy is safe for HER2-positive and triple negative breast cancer patients over 70 years of age

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Abstract

Purpose

The prognosis of elderly patients with hormone receptor-positive breast cancer is very good, and their survival is unaffected by performing breast-conserving surgery (BCS) without radiotherapy. Therefore, we aimed to verify that BCS without axillary lymph node dissection, sentinel lymph node biopsy, or radiotherapy (BCSNR) is safe for patients over 70 years of age with luminal-type breast cancer, as well as for those with HER2-positive and triple negative breast cancer (TNBC).

Methods

This study retrospectively included 450 patients > 70-year-old with breast cancer from 2010 to 2016. The patients were divided into two groups, one treated with BCSNR and the other treated with mastectomy and axillary lymph node dissection (MALND), with a median follow-up period of 5 years. Disease-free survival (DFS), overall survival, local recurrence, distant metastasis, and ipsilateral breast tumor recurrence (IBTR) were compared between the two groups.

Results

The 5-year DFS for patients who underwent BCSNR and MALND was 90.1 and 91.3% (p = 0.903), respectively. In the BCSNR and MALND groups, respectively, the 5-year DFS for patients with luminal A type breast cancer was 99.2 and 100% (p = 0.167), that for patients with luminal B type breast cancer was 89.2 and 95.5% (p = 0.138), that for patients with HER2-positive breast cancer was 86.7 and 75.9% (p = 0.455), and that for TNBC patients was 71.7 and 89.7% (p = 0.195). IBTR significantly differed between the BCSNR and MALND groups for patients with TNBC (18.9% vs 0.0%, p = 0.040) and luminal B type patients (5.6% vs 0.0%, p = 0.043).

Conclusion

BCSNR is not only suitable for elderly patients with luminal-type breast cancer but also for those with HER2-positive breast cancer and TNBC.

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References

  1. Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  Google Scholar 

  2. Clèries R, Rooney RM, Vilardell M et al (2018) Assessing predicted age-specific breast cancer mortality rates in 27 European countries by 2020. Clin Transl Oncol 20(3):313–321

    Article  Google Scholar 

  3. Héry C, Ferlay J, Boniol M et al (2008) Changes in breast cancer incidence and mortality in middle-aged and elderly women in 28 countries with Caucasian majority populations. Ann Oncol 19(5):1009–1018

    Article  Google Scholar 

  4. Muss HB, Woolf S, Berry D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 293(9):1073–1081

    Article  CAS  Google Scholar 

  5. Ring A, Sestak I, Baum M et al (2011) Influence of comorbidities and age on risk of death without recurrence: a retrospective analysis of the Arimidex, Tamoxifen Alone or in Combination trial. J Clin Oncol 29(32):4266–4272

    Article  CAS  Google Scholar 

  6. de Glas NA, Kiderlen M, Bastiaannet E et al (2013) Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat 138(2):561–569

    Article  Google Scholar 

  7. Jenkins EO, Deal AM, Anders CK et al (2014) Age-specific changes in intrinsic breast cancer subtypes: a focus on older women. Oncologist 19(10):1076–1083

    Article  Google Scholar 

  8. Syed BM, Al-Khyatt W, Johnston SJ et al (2011) Long-term clinical outcome of oestrogen receptor-positive operable primary breast cancer in older women: a large series from a single centre. Br J Cancer 104(9):1393–1400

    Article  CAS  Google Scholar 

  9. Walter LC, Covinsky KE (2001) Cancer screening in elderly patients: a framework for individualized decision making. JAMA 285(21):2750–2756

    Article  CAS  Google Scholar 

  10. Johnston SJ, Kenny FS, Syed BM et al (2012) A randomised trial of primary tamoxifen versus mastectomy plus adjuvant tamoxifen in fit elderly women with invasive breast carcinoma of high oestrogen receptor content: long-term results at 20 years of follow-up. Ann Oncol 23(9):2296–2300

    Article  CAS  Google Scholar 

  11. International Breast Cancer Study Group (2006) Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol 24(3):337–344

    Article  Google Scholar 

  12. Martelli G, Miceli R, Daidone MG et al (2011) Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol 18(1):125–133

    Article  Google Scholar 

  13. Kunkler IH, Williams LJ, Jack WJ et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 16(3):266–273

    Article  Google Scholar 

  14. Wolff AC, Hammond ME, Hicks DG et al (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31(31):3997–4013

    Article  Google Scholar 

  15. Lakhani SR, Ellis IO, Schnitt SJ et al (2012) WHO classification of tumours of the breast. Fourth edition

  16. Prat A, Pineda E, Adamo B et al (2015) Clinical implications of the intrinsic molecular subtypes of breast cancer. Breast 24(Suppl 2):S26–S35

    Article  Google Scholar 

  17. Killander F, Karlsson P, Anderson H et al (2016) No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT. Eur J Cancer 67:57–65

    Article  CAS  Google Scholar 

  18. Vaidya JS, Bulsara M, Wenz F (2013) Ischemic heart disease after breast cancer radiotherapy. N Engl J Med 368(26):2526–2527

    PubMed  Google Scholar 

  19. Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

    Article  Google Scholar 

  20. Early Breast Cancer Trialists’ Collaborative Group (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716

    Article  Google Scholar 

  21. Veronesi U, Marubini E, Mariani L et al (2001) Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12(7):997–1003

    Article  CAS  Google Scholar 

  22. Liljegren G, Holmberg L, Bergh J et al (1999) 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol 17(8):2326–2333

    Article  CAS  Google Scholar 

  23. Malmström P, Holmberg L, Anderson H et al (2003) Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening. Eur J Cancer 39(12):1690–1697

    Article  Google Scholar 

  24. Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351(10):971–977

    Article  CAS  Google Scholar 

  25. Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31(19):2382–2387

    Article  CAS  Google Scholar 

  26. Wickberg A, Liljegren G, Killander F et al (2018) Omitting radiotherapy in women ≥ 65 years with low-risk early breast cancer after breast-conserving surgery and adjuvant endocrine therapy is safe. Eur J Surg Oncol 44(7):951–956

    Article  Google Scholar 

  27. Chung A, Gangi A, Amersi F et al (2015) Not performing a sentinel node biopsy for older patients with early-stage invasive breast cancer. JAMA Surg 150(7):683–684

    Article  Google Scholar 

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Acknowledgements

We would like to thank all of our patients for participating in this study and everyone who contributed towards the article who does not meet the criteria for authorship. This study was supported by the Natural Science Foundation of Beijing Municipality (Grant Number 7172168) and Fundamental Research Funds for the Central Universities (3332018020).

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Authors and Affiliations

  1. Department of Breast Disease, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China

    Ying Zhong, Yali Xu, Yidong Zhou, Feng Mao, Yan Lin, Jinghong Guan, Songjie Shen, Bo Pan, Changjun Wang, Li Peng, Xin Huang, Yan Li, Xuefei Wang & Qiang Sun

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  1. Ying Zhong
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  2. Yali Xu
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  3. Yidong Zhou
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  4. Feng Mao
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  5. Yan Lin
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  6. Jinghong Guan
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  7. Songjie Shen
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  11. Xin Huang
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  12. Yan Li
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Corresponding author

Correspondence to Qiang Sun.

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Conflict of interest

No competing interests exist in the submission of this manuscript, and the manuscript is approved by all authors for publication.

Ethical approval

The study was approved by the Institutional Review Board of Peking Union Medical College Hospital (S-K971).

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All patients provided written informed consent for participation and all the patients’ data were anonymous.

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Zhong, Y., Xu, Y., Zhou, Y. et al. Breast-conserving surgery without axillary lymph node surgery or radiotherapy is safe for HER2-positive and triple negative breast cancer patients over 70 years of age. Breast Cancer Res Treat 182, 117–126 (2020). https://doi.org/10.1007/s10549-020-05686-3

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  • DOI: https://doi.org/10.1007/s10549-020-05686-3

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