Role of postmastectomy radiotherapy in early-stage (T1–2N0–1M0) triple-negative breast cancer: a systematic review

Figures & data

Table 1 Breast conservation therapy versus mastectomy

Study ID, country/region	Study design	Study size, TNBC cases	Age (years)	Follow-up time (years)	Stage of disease	Treatment	Survival estimates
Abdulkarim et al,^Citation34 Canada	Retrospective cohort study	768, 468 (T1–2N0)	Median: 56	Median: 7.2	T1–3, N0–2	BCT vs M	Five-year LRR-free survival for T1–2N0: 96% vs 90% (P=0.022) OS: NR
Wang et al,^Citation35 China	Meta-analysis (one RCT and the remaining are retrospective observational studies)	4,364, 962 (stages I–II)	Median: 55	Median: 5.8	0–IV	BCT vs M	ILRR: 16.9% vs 21.9% (P<0.0001) DM: 23.6% vs 34.4% (P<0.00001)
Zumsteg et al,^Citation36 USA	Retrospective cohort study	646	Median: 59	Median: 6.5	T1–2, N0	BCT vs M	5-year LRR: 4.2% vs 5.4% (P>0.05) 5-year DM: 8.2% vs 8.1% (P=0.92) OS: P=0.762
Bhoo-Pathy et al,^Citation37 Asia	Retrospective cohort study	1,138, 775 (T1–2N0–1M0)	Median: 53	Median: 3.6	T1–4, N0–3	BCT vs M	5-year RSR: 90.8% vs 94.7% (P>0.05)
Ly et al,^Citation38 USA	Retrospective cohort study	62	NR	Median: 3.3	T1–2, N0–1	BCT vs M	7-year LRR: 19.7% vs 17.5% (P=0.465) 7-year RFS: 77.6% vs 60.2% (P=0.193) 7-year DM: 2.63% vs 22.4% (P<0.0001)
van Maaren et al,^Citation39 the Netherlands	Retrospective cohort study	37,207 (all types)	NR	Median: 11.4	T1–2N0–1M0	BCT vs M	10-year OS: 77% vs 60% (P<0.05)

Abbreviations: M, mastectomy; TNBC, triple-negative breast cancer; BCT, breast-conserving therapy; LRR, locoregional recurrence; OS, overall survival; NR, not reported; RCT, randomized controlled trial; ILRR, ipsilateral locoregional recurrence; DM, distant metastasis; RSR, relative survival ratio; RFS, relapse-free survival.

Table 2 Mastectomy versus mastectomy + PMRT

Study ID, country/region	Study design	Study size, TNBC cases	Age (years)	Follow-up, time (years)	Stage of disease	Treatment	Survival estimates
Chen et al,^Citation40 China	Retrospective cohort study	553, 416 (T1–2N0–1M0)	Median: 52	Median: 5.4	T1–4, N0–3	M + PMRT vs M	DFS: HR 16.41; 95% CI, 1.61–167.11; P=0.018
Kong and Hong,^Citation41 Korea	Retrospective cohort study	14	Median: 48.6	Median: 7	T1–2N1	M + PMRT vs M	NR
Gabos et al,^Citation42 Canada	Retrospective cohort study	74	NR	Median: 4.8	NR	M + PMRT vs M	NR
Wang et al,^Citation43 China	RCT	681	NR	Median: 7.2	T1–2, N0–3	M + PMRT vs M	Five-year RFS: 88.3% vs 74.6% (P=0.02) Five-year OS: 90.4% vs 78.7% (P=0.03)
Jagsi et al,^Citation44 USA	Retrospective cohort study	NR	Median: 64	Median: 8.3	T1–3N0	M	10-year LRR: 6.0%
Truong et al,^Citation45 Canada	Retrospective cohort study	NR	Median: 62	Median: 7	T1–2N0	BCS and M	10-year LRR: 7.8% DM: 11.7% 10-year BCSS: 88.4% 10-year OS: 74.7%
Shen et al,^Citation46 China	Retrospective cohort study	167	Median: 50	Median: 6.1	T1–2N1	M + PMRT vs M	LRR: 34% vs 19.2%

Abbreviations: M, mastectomy; PMRT, postmastectomy radiotherapy; TNBC, triple-negative breast cancer; DFS, disease-free survival; HR, hazard ratio; CI, confidence interval; NR, not reported; RCT, randomized controlled trial; RFS, relapse-free survival; OS, overall survival; LRR, locoregional recurrence; BCS, breast-conserving surgery; DM, distant metastasis; BCSS, breast cancer-specific survival.

Table 3 Association with clinicopathologic factors

Study ID, country/region	Study design	Study size, TNBC cases	Age (years)	Follow-up, time (years)	Stage of disease	Treatment	Adjustments
Chen et al,^Citation47 China	Retrospective study	390	Median: 53	Median: 5	T1–2N0–1M0	M	Age, LVI, grade, NPLN, CT, tumor size
Shen et al,^Citation46 China	Retrospective cohort study	167	Median: 50	Median: 6.1	T1–2N1	M + PMRT vs M	Age, LVI, NPLN, RPLN
Trovo et al,^Citation48 Italy	Retrospective study	NR	Median: 56	Median: 6.2	I–II	M	LVI, grade, menopausal status, ER status, 5-year LRR rate
Truong et al,^Citation49 Canada	Retrospective study	NR	Median: 62	Median: 7.7	T1–2N1	M	Age, tumor size, NPLN, grade, tumor location, RPLN
Houvenaeghel et al,^Citation50 France	Retrospective study	1,237	Median: 56	NR	T1–3N0–1M0	Surgery and CT	Tumor size, grade, ALNI, CT
Chen et al,^Citation40 China	Retrospective cohort study	553, 416 (T1–2N0–1M0)	Median: 52	Median: 5.4	T1–4, N0–3	M + PMRT vs M	Age, tumor size, NPLN, LVI, grade, CT

Abbreviations: TNBC, triple-negative breast cancer; M, mastectomy; LVI, lymphovascular invasion; NPLN, number of positive lymph nodes; CT, adjuvant chemotherapy; PMRT, postmastectomy radiotherapy; RPLN, ratio of positive lymph nodes; NR, not reported; ER, estrogen receptor; LRR, locoregional recurrence; ALNI, axillary lymph node involvement.

AbdulkarimBSCuarteroJHansonJDeschênesJLesniakDSabriSIncreased risk of locoregional recurrence for women with T1–2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapyJ Clin Oncol201129212852285821670451

 PubMedGoogle Scholar

WangJXieXWangXLocoregional and distant recurrences after breast conserving therapy in patients with triple-negative breast cancer: a meta-analysisSurg Oncol201322424725524144808

 PubMedGoogle Scholar

ZumstegZSMorrowMArnoldBBreast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1–2N0 triple-negative breast cancerAnn Surg Oncol201320113469347623686101

 PubMed Web of Science ®Google Scholar

Bhoo-PathyNVerkooijenHMWongFYPrognostic role of adjuvant radiotherapy in triple-negative breast cancer: a historical cohort studyInt J Cancer2015137102504251226018878

 PubMedGoogle Scholar

LyBKwonDReisIComparison of clinical outcomes in early stage triple negative breast cancer treated with mastectomy versus breast conserving therapyInt J Radiat Oncol Biol Phys201284S258S259

 Google Scholar

van MaarenMCde MunckLde BockGH10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based studyLancet Oncol20161781158117027344114

 PubMed Web of Science ®Google Scholar

ChenXYuXChenJRadiotherapy can improve the disease-free survival rate in triple-negative breast cancer patients with T1–T2 disease and one to three positive lymph nodes after mastectomyOncologist201318214114723335622

 PubMedGoogle Scholar

KongMHongSEWhich patients might benefit from postmastectomy radiotherapy in breast cancer patients with t1–2 tumor and 1–3 axillary lymph nodes metastasis?Cancer Res Treat201345210311123864843

 PubMedGoogle Scholar

GabosZThomsJGhoshSThe association between biological subtype and locoregional recurrence in newly diagnosed breast cancerBreast Cancer Res Treat2010124118719420814819

 PubMed Web of Science ®Google Scholar

WangJShiMLingRAdjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trialRadiother Oncol2011100220020421852010

 PubMedGoogle Scholar

JagsiRRaadRAGoldbergSLocoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy: implications for postmastectomy radiationInt J Radiat Oncol Biol Phys20056241035103915990006

 PubMed Web of Science ®Google Scholar

TruongPTLesperanceMCulhaciAKaderHASpeersCHOlivottoIAPatient subsets with T1–T2, node-negative breast cancer at high locoregional recurrence risk after mastectomyInt J Radiat Oncol Biol Phys200562117518215850919

 PubMedGoogle Scholar

ShenHZhaoLWangLPostmastectomy radiotherapy benefit in Chinese breast cancer patients with T1–T2 tumor and 1–3 positive axillary lymph nodes by molecular subtypes: an analysis of 1369 casesTumour Biol20163756465647526631044

 PubMedGoogle Scholar

ChenXYuXChenJAnalysis in early stage triple-negative breast cancer treated with mastectomy without adjuvant radiotherapy: patterns of failure and prognostic factorsCancer2013119132366237423576181

 PubMed Web of Science ®Google Scholar

TrovoMDurofilEPoleselJLocoregional failure in early-stage breast cancer patients treated with radical mastectomy and adjuvant systemic therapy: which patients benefit from postmastectomy irradiation?Int J Radiat Oncol Biol Phys2012832e153e15722386375

 PubMed Web of Science ®Google Scholar

TruongPTOlivottoIAKaderHAPanadesMSpeersCHBertheletESelecting breast cancer patients with T1–T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapyInt J Radiat Oncol Biol Phys20056151337134715817335

 PubMed Web of Science ®Google Scholar

HouvenaeghelGSabatierRReyalFAxillary lymph node micrometastases decrease triple-negative early breast cancer survivalBr J Cancer201611591024103127685443

 PubMed Web of Science ®Google Scholar