Clinicopathological features and guiding significance for radiotherapy of pT1-2N1M0 breast cancer with different molecular subtypes_West China Medical Journal

Authors：

YU Siting ¹ , WANG Jun ¹ ,  LIU Lei ¹ ,  LUO Ting ²

1. Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Lei, Email: liuleihx@gmail.com; LUO Ting, Email: luoting@wchscu.cn

Keywords：

Breast cancer; Luminal subtypes; clinicopathological features; survival analysis; radiotherapy

DOI：

10.7507/1002-0179.202302178

Video：

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Objective To investigate the prognostic differences and decision-making role in postoperative radiotherapy of four molecular subtypes in pT1-2N1M0 stage breast cancer. Methods The clinicopathological data of 1526 patients with pT1-2N1M0 breast cancer treated at West China Hospital of Sichuan University between 2008 and 2018 were retrospectively analyzed. χ²test was used to compare the clinicopathological features among patients with different molecular subtypes. Kaplan-Meier survival analysis and log-rank test were used to draw the survival curves and compare the overall survival (OS) and breast cancer-specific survival (BCSS) among patients with different molecular subtypes. Cox regression model was used to determine the influencing factors of OS of patients after radical mastectomy. Results Among the 1526 patients with pT1-2N1M0 breast cancer, there were 674 cases (44.2%) of Luminal A subtype, 530 cases (34.7%) of Luminal B subtype, 174 cases (11.4%) of human epidermal growth factor receptor 2 (Her-2) overexpression subtype, and 148 cases (9.7%) of triple-negative subtype. The 5-year OS rates of Luminal A, Luminal B, Her-2 overexpression and triple negative patients were 98.6%, 94.3%, 95.5% and 91.2%, respectively (χ²=11.712, P=0.001), and the 5-year BCSS rates were 99.3%, 94.6%, 95.5% and 92.5%, respectively (χ²=18.547, P<0.001). Multiple Cox regression analysis showed that menstrual status [hazard ratio (HR)=0.483, 95% confidence interval (CI) (0.253, 0.923), P=0.028] and whether endocrine therapy [HR=2.021, 95%CI (1.012, 4.034), P=0.046] were prognostic factors for the 5-year OS rate of breast cancer patients after radical mastectomy (P<0.05). However, it failed to reveal that Luminal subtypes and postoperative radiotherapy were prognostic factors for the 5-year OS rate (P>0.05). Conclusions In pT1-2N1M0 breast cancer patients, the 5-year OS rate and 5-year BCSS rate in triple-negative patients are the lowest. The relationship between Luminal classification, postoperative radiotherapy and survival in patients after radical mastectomy needs further study in the future.

Citation： YU Siting, WANG Jun, LIU Lei, LUO Ting. Clinicopathological features and guiding significance for radiotherapy of pT1-2N1M0 breast cancer with different molecular subtypes. West China Medical Journal, 2025, 40(1): 42-47. doi: 10.7507/1002-0179.202302178 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3.	Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast, 2022, 66: 15-23.
4.	Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1455.
5.	Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 2011, 22(8): 1736-1747.
6.	Wei J, Jiang Y, Shao Z. The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype. Breast, 2020, 51: 40-49.
7.	DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin, 2019, 69(6): 438-451.
8.	Morey BN, Gee GC, von Ehrenstein OS, et al. Higher breast cancer risk among immigrant Asian American women than among US-born Asian American women. Prev Chronic Dis, 2019, 16: E20.
9.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021 年版). 中国癌症杂志, 2021, 31(10): 954-1040.
10.	Ren X, Song Y, Zhang Y, et al. Prognostic significance of different molecular typing methods and immune status based on RNA sequencing in HR-positive and HER2-negative early-stage breast cancer. BMC Cancer, 2022, 22(1): 548.
11.	Wang GS, Zhu H, Bi SJ. Pathological features and prognosis of different molecular subtypes of breast cancer. Mol Med Rep, 2012, 6(4): 779-782.
12.	中国临床肿瘤学会乳腺癌专家委员会, 中国抗癌协会乳腺癌专业委员会. 人表皮生长因子受体 2 阳性乳腺癌临床诊疗专家共识(2021 版). 中华医学杂志, 2021, 101(17): 1226-1231.
13.	Turner KM, Yeo SK, Holm TM, et al. Heterogeneity within molecular subtypes of breast cancer. Am J Physiol Cell Physiol, 2021, 321(2): C343-C354.
14.	Rossing M, Pedersen CB, Tvedskov T, et al. Clinical implications of intrinsic molecular subtypes of breast cancer for sentinel node status. Sci Rep, 2021, 11(1): 2259.
15.	Gao JJ, Swain SM. Luminal A breast cancer and molecular assays: a review. Oncologist, 2018, 23(5): 556-565.
16.	McGuire A, Brown JA, Malone C, et al. Effects of age on the detection and management of breast cancer. Cancers (Basel), 2015, 7(2): 908-929.
17.	Spitale A, Mazzola P, Soldini D, et al. Breast cancer classification according to immunohistochemical markers: clinicopathologic features and short-term survival analysis in a population-based study from the South of Switzerland. Ann Oncol, 2009, 20(4): 628-635.
18.	Yang XR, Sherman ME, Rimm DL, et al. Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev, 2007, 16(3): 439-443.
19.	Tseng YD, Uno H, Hughes ME, et al. Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database. Int J Radiat Oncol Biol Phys, 2015, 93(3): 622-630.
20.	Muhsen S, Moo TA, Patil S, et al. Most breast cancer patients with T1-2 tumors and one to three positive lymph nodes do not need postmastectomy radiotherapy. Ann Surg Oncol, 2018, 25(7): 1912-1920.
21.	Xia LY, Xu WY, Zhao Y. Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer. PLoS One, 2022, 17(6): e0270528.
22.	Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1-2 patients with one to three positive lymph nodes - Past, present and future. Breast, 2019, 48: 73-81.
23.	Park HJ, Shin KH, Kim JH, et al. Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in N1 breast cancer treated with optimal systemic therapy: a multicenter analysis in Korea (KROG 14-23). Cancer Res Treat, 2017, 49(3): 739-747.
24.	He MY, Rancoule C, Rehailia-Blanchard A, et al. Radiotherapy in triple-negative breast cancer: current situation and upcoming strategies. Crit Rev Oncol Hematol, 2018, 131: 96-101.

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3. Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast, 2022, 66: 15-23.
4. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1455.
5. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 2011, 22(8): 1736-1747.
6. Wei J, Jiang Y, Shao Z. The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype. Breast, 2020, 51: 40-49.
7. DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin, 2019, 69(6): 438-451.
8. Morey BN, Gee GC, von Ehrenstein OS, et al. Higher breast cancer risk among immigrant Asian American women than among US-born Asian American women. Prev Chronic Dis, 2019, 16: E20.
9. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021 年版). 中国癌症杂志, 2021, 31(10): 954-1040.
10. Ren X, Song Y, Zhang Y, et al. Prognostic significance of different molecular typing methods and immune status based on RNA sequencing in HR-positive and HER2-negative early-stage breast cancer. BMC Cancer, 2022, 22(1): 548.
11. Wang GS, Zhu H, Bi SJ. Pathological features and prognosis of different molecular subtypes of breast cancer. Mol Med Rep, 2012, 6(4): 779-782.
12. 中国临床肿瘤学会乳腺癌专家委员会, 中国抗癌协会乳腺癌专业委员会. 人表皮生长因子受体 2 阳性乳腺癌临床诊疗专家共识(2021 版). 中华医学杂志, 2021, 101(17): 1226-1231.
13. Turner KM, Yeo SK, Holm TM, et al. Heterogeneity within molecular subtypes of breast cancer. Am J Physiol Cell Physiol, 2021, 321(2): C343-C354.
14. Rossing M, Pedersen CB, Tvedskov T, et al. Clinical implications of intrinsic molecular subtypes of breast cancer for sentinel node status. Sci Rep, 2021, 11(1): 2259.
15. Gao JJ, Swain SM. Luminal A breast cancer and molecular assays: a review. Oncologist, 2018, 23(5): 556-565.
16. McGuire A, Brown JA, Malone C, et al. Effects of age on the detection and management of breast cancer. Cancers (Basel), 2015, 7(2): 908-929.
17. Spitale A, Mazzola P, Soldini D, et al. Breast cancer classification according to immunohistochemical markers: clinicopathologic features and short-term survival analysis in a population-based study from the South of Switzerland. Ann Oncol, 2009, 20(4): 628-635.
18. Yang XR, Sherman ME, Rimm DL, et al. Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev, 2007, 16(3): 439-443.
19. Tseng YD, Uno H, Hughes ME, et al. Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database. Int J Radiat Oncol Biol Phys, 2015, 93(3): 622-630.
20. Muhsen S, Moo TA, Patil S, et al. Most breast cancer patients with T1-2 tumors and one to three positive lymph nodes do not need postmastectomy radiotherapy. Ann Surg Oncol, 2018, 25(7): 1912-1920.
21. Xia LY, Xu WY, Zhao Y. Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer. PLoS One, 2022, 17(6): e0270528.
22. Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1-2 patients with one to three positive lymph nodes - Past, present and future. Breast, 2019, 48: 73-81.
23. Park HJ, Shin KH, Kim JH, et al. Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in N1 breast cancer treated with optimal systemic therapy: a multicenter analysis in Korea (KROG 14-23). Cancer Res Treat, 2017, 49(3): 739-747.
24. He MY, Rancoule C, Rehailia-Blanchard A, et al. Radiotherapy in triple-negative breast cancer: current situation and upcoming strategies. Crit Rev Oncol Hematol, 2018, 131: 96-101.

West China Medical Journal

Clinicopathological features and guiding significance for radiotherapy of pT1-2N1M0 breast cancer with different molecular subtypes

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