Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients

BackgroundThe treatment for locally advanced breast cancer (LABC) is a severe clinical problem. The postoperative radiotherapy is a conventional treatment method for patients with LABC, whereas the effect of preoperative radiotherapy on outcome of LABC remains controversial. This study aimed to exam...

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Autores principales:	Yujiao Deng, Hongtao Li, Yi Zheng, Zhen Zhai, Meng Wang, Shuai Lin, Yizhen Li, Bajin Wei, Peng Xu, Ying Wu, Xinyue Deng, Si Yang, Jun Lyu, Jingjing Hu, Huaying Dong, Zhijun Dai
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	locally advanced breast cancer National Cancer Database preoperative radiotherapy postoperative radiotherapy overall survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/1f8b4a6212ab45d7aa92eb23924350a1
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spelling	oai:doaj.org-article:1f8b4a6212ab45d7aa92eb23924350a12021-11-30T13:04:35ZImpact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients2234-943X10.3389/fonc.2021.779185https://doaj.org/article/1f8b4a6212ab45d7aa92eb23924350a12021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.779185/fullhttps://doaj.org/toc/2234-943XBackgroundThe treatment for locally advanced breast cancer (LABC) is a severe clinical problem. The postoperative radiotherapy is a conventional treatment method for patients with LABC, whereas the effect of preoperative radiotherapy on outcome of LABC remains controversial. This study aimed to examine and compare the overall survival (OS) in patients with LABC who underwent preoperative radiotherapy or postoperative radiotherapy.MethodsThis retrospective cohort study included 41,618 patients with LABC from the National Cancer Database (NCDB) between 2010 and 2014. We collected patients’ demographic, clinicopathologic, treatment and survival information. Propensity score was used to match patients underwent pre-operative radiotherapy with those who underwent post-operative radiotherapy. Cox proportional hazard regression model was performed to access the association between variables and OS. Log-rank test was conducted to evaluate the difference in OS between groups.ResultsThe estimated median follow-up of all included participants was 69.6 months (IQR: 42.84-60.22); 70.1 months (IQR: 46.85-79.97) for postoperative radiotherapy, 68.5 (IQR: 41.13-78.23) for preoperative radiotherapy, and 67.5 (IQR: 25.92-70.99) for no radiotherapy. The 5-year survival rate was 80.01% (79.56-80.47) for LABC patients who received postoperative radiotherapy, 64.08% (57.55-71.34) for preoperative radiotherapy, and 59.67% (58.60-60.77) for no radiotherapy. Compared with no radiation, patients receiving postoperative radiotherapy had a 38% lower risk of mortality (HR=0.62, 95%CI: 0.60-0.65, p<0.001), whereas those who received preoperative radiotherapy had no significant survival benefit (HR=0.88, 95%CI: 0.70-1.11, p=0.282). Propensity score matched analysis indicated that patients treated with preoperative radiotherapy had similar outcomes as those treated with postoperative radiotherapy (AHR=1.23, 95%CI: 0.88-1.72, p=0.218). Further analysis showed that in C0 (HR=1.45, 95%CI: 1.01-2.07, p=0.044) and G1-2 (AHR=1.74, 95%CI: 1.59-5.96, p=0.001) subgroup, patients receiving preoperative radiotherapy showed a worse OS than those who received postoperative radiotherapy.ConclusionsPatients with LABC underwent postoperative radiotherapy had improved overall survival, whereas no significant survival benefit was observed in patients receiving preoperative radiotherapy. Preoperative radiotherapy did not present a better survival than postoperative radiotherapy for LABC patients.Yujiao DengYujiao DengHongtao LiYi ZhengYi ZhengZhen ZhaiZhen ZhaiMeng WangShuai LinYizhen LiYizhen LiBajin WeiPeng XuYing WuXinyue DengSi YangSi YangJun LyuJingjing HuHuaying DongZhijun DaiZhijun DaiFrontiers Media S.A.articlelocally advanced breast cancerNational Cancer Databasepreoperative radiotherapypostoperative radiotherapyoverall survivalNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	locally advanced breast cancer National Cancer Database preoperative radiotherapy postoperative radiotherapy overall survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	locally advanced breast cancer National Cancer Database preoperative radiotherapy postoperative radiotherapy overall survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Yujiao Deng Yujiao Deng Hongtao Li Yi Zheng Yi Zheng Zhen Zhai Zhen Zhai Meng Wang Shuai Lin Yizhen Li Yizhen Li Bajin Wei Peng Xu Ying Wu Xinyue Deng Si Yang Si Yang Jun Lyu Jingjing Hu Huaying Dong Zhijun Dai Zhijun Dai Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
description	BackgroundThe treatment for locally advanced breast cancer (LABC) is a severe clinical problem. The postoperative radiotherapy is a conventional treatment method for patients with LABC, whereas the effect of preoperative radiotherapy on outcome of LABC remains controversial. This study aimed to examine and compare the overall survival (OS) in patients with LABC who underwent preoperative radiotherapy or postoperative radiotherapy.MethodsThis retrospective cohort study included 41,618 patients with LABC from the National Cancer Database (NCDB) between 2010 and 2014. We collected patients’ demographic, clinicopathologic, treatment and survival information. Propensity score was used to match patients underwent pre-operative radiotherapy with those who underwent post-operative radiotherapy. Cox proportional hazard regression model was performed to access the association between variables and OS. Log-rank test was conducted to evaluate the difference in OS between groups.ResultsThe estimated median follow-up of all included participants was 69.6 months (IQR: 42.84-60.22); 70.1 months (IQR: 46.85-79.97) for postoperative radiotherapy, 68.5 (IQR: 41.13-78.23) for preoperative radiotherapy, and 67.5 (IQR: 25.92-70.99) for no radiotherapy. The 5-year survival rate was 80.01% (79.56-80.47) for LABC patients who received postoperative radiotherapy, 64.08% (57.55-71.34) for preoperative radiotherapy, and 59.67% (58.60-60.77) for no radiotherapy. Compared with no radiation, patients receiving postoperative radiotherapy had a 38% lower risk of mortality (HR=0.62, 95%CI: 0.60-0.65, p<0.001), whereas those who received preoperative radiotherapy had no significant survival benefit (HR=0.88, 95%CI: 0.70-1.11, p=0.282). Propensity score matched analysis indicated that patients treated with preoperative radiotherapy had similar outcomes as those treated with postoperative radiotherapy (AHR=1.23, 95%CI: 0.88-1.72, p=0.218). Further analysis showed that in C0 (HR=1.45, 95%CI: 1.01-2.07, p=0.044) and G1-2 (AHR=1.74, 95%CI: 1.59-5.96, p=0.001) subgroup, patients receiving preoperative radiotherapy showed a worse OS than those who received postoperative radiotherapy.ConclusionsPatients with LABC underwent postoperative radiotherapy had improved overall survival, whereas no significant survival benefit was observed in patients receiving preoperative radiotherapy. Preoperative radiotherapy did not present a better survival than postoperative radiotherapy for LABC patients.
format	article
author	Yujiao Deng Yujiao Deng Hongtao Li Yi Zheng Yi Zheng Zhen Zhai Zhen Zhai Meng Wang Shuai Lin Yizhen Li Yizhen Li Bajin Wei Peng Xu Ying Wu Xinyue Deng Si Yang Si Yang Jun Lyu Jingjing Hu Huaying Dong Zhijun Dai Zhijun Dai
author_facet	Yujiao Deng Yujiao Deng Hongtao Li Yi Zheng Yi Zheng Zhen Zhai Zhen Zhai Meng Wang Shuai Lin Yizhen Li Yizhen Li Bajin Wei Peng Xu Ying Wu Xinyue Deng Si Yang Si Yang Jun Lyu Jingjing Hu Huaying Dong Zhijun Dai Zhijun Dai
author_sort	Yujiao Deng
title	Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
title_short	Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
title_full	Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
title_fullStr	Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
title_full_unstemmed	Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients
title_sort	impact of preoperative vs postoperative radiotherapy on overall survival of locally advanced breast cancer patients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/1f8b4a6212ab45d7aa92eb23924350a1
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Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients

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