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The role of postmastectomy radiation in patients with ypN0 breast cancer after neoadjuvant chemotherapy: a meta-analysis
Jian Huang
Second Affiliated Hospital of Zhejiang University
Corresponding Author
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Background: It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. However, the effectiveness of radiotherapy in pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains open to considerable debate. Here, we aim to evaluate whether PMRT improves loco-regional control and survival for such patients.
Methods: The literature from January 2004 to June 2019 was searched. The effects of PMRT on local-regional recurrence (LRR) and survival was evaluated in a meta-analysis. Pooled relative risk (RR) values with 95% confidence intervals (CIs) were computed using random and fixed-effects models. Subgroup and heterogeneity analyses were also conducted.
Results: Ten studies that included 29,860 patients met the inclusion criteria. Pooled results showed that PMRT was associated with reduced LRR (RR, 0.38; 95% CI, 0.19-0.77, P = 0.007), particularly in patients with stage III-IV breast cancer (RR, 0.16; 95% CI, 0.07-0.37, P < 0.001). However, no significant difference in disease-free survival were observed with the addition of PMRT for ypN0 patients (RR, 0.70; 95% CI, 0.21–2.27, P = 0.55). Also, there was no statistically significant association between radiotherapy with overall survival (RR, 0.81; 95% CI, 0.64-1.04, P = 0.10).
Conclusions: Our meta-analysis indicated that PMRT might reduce local-regional recurrence for ypN0 patients after NAC, but lake of benefit for survival outcomes. Prospective randomized clinical trial data will be needed to confirm our results.
Keywords
Breast cancer, Neoadjuvant chemotherapy, Postmastectomy radiation therapy, Negative lymph nodes, Prognosis, Meta-analysis
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Supplementary Table 1
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Supplementary Figure S1. A funnel plot of studies that reported LRR or survival outcomes. (A) LRR; (B) DFS; (C) OS.
- Figures1.tif
Supplementary Figure S1. A funnel plot of studies that reported LRR or survival outcomes. (A) LRR; (B) DFS; (C) OS.
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Reviewer #11 agreed
On 19 Dec, 2020
Reviewer #12 agreed
On 19 Dec, 2020
Reviewer #8 agreed
On 19 Dec, 2020
Reviewer #10 agreed
On 19 Dec, 2020
Reviewer #1 agreed
On 19 Dec, 2020
Reviewer #9 agreed
On 19 Dec, 2020
Reviewer #3 agreed
On 19 Dec, 2020
Reviewer #4 agreed
On 19 Dec, 2020
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On 16 Dec, 2020
Editor invited
On 15 Dec, 2020
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On 15 Dec, 2020
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Subject Areas
Oncology
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This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
The role of postmastectomy radiation in patients with ypN0 breast cancer after neoadjuvant chemotherapy: a meta-analysis
Jian Huang
Second Affiliated Hospital of Zhejiang University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 16 Dec, 2020
No community comments so far
Review #2 received
Received 12 Jan, 2021
Reviewer #2 agreed
On 10 Jan, 2021
Review #8 received
Received 03 Jan, 2021
Review #9 received
Received 03 Jan, 2021
Review #5 received
Received 03 Jan, 2021
Review #7 received
Received 03 Jan, 2021
Review #6 received
Received 03 Jan, 2021
Review #1 received
Received 03 Jan, 2021
Reviewer #11 agreed
On 19 Dec, 2020
Reviewer #12 agreed
On 19 Dec, 2020
Reviewer #8 agreed
On 19 Dec, 2020
Reviewer #10 agreed
On 19 Dec, 2020
Reviewer #1 agreed
On 19 Dec, 2020
Reviewer #9 agreed
On 19 Dec, 2020
Reviewer #3 agreed
On 19 Dec, 2020
Reviewer #4 agreed
On 19 Dec, 2020
Reviewers invited
Invitations sent on 16 Dec, 2020
Editor assigned
On 16 Dec, 2020
Editor invited
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
First submitted
On 28 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. However, the effectiveness of radiotherapy in pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains open to considerable debate. Here, we aim to evaluate whether PMRT improves loco-regional control and survival for such patients.
Methods: The literature from January 2004 to June 2019 was searched. The effects of PMRT on local-regional recurrence (LRR) and survival was evaluated in a meta-analysis. Pooled relative risk (RR) values with 95% confidence intervals (CIs) were computed using random and fixed-effects models. Subgroup and heterogeneity analyses were also conducted.
Results: Ten studies that included 29,860 patients met the inclusion criteria. Pooled results showed that PMRT was associated with reduced LRR (RR, 0.38; 95% CI, 0.19-0.77, P = 0.007), particularly in patients with stage III-IV breast cancer (RR, 0.16; 95% CI, 0.07-0.37, P < 0.001). However, no significant difference in disease-free survival were observed with the addition of PMRT for ypN0 patients (RR, 0.70; 95% CI, 0.21–2.27, P = 0.55). Also, there was no statistically significant association between radiotherapy with overall survival (RR, 0.81; 95% CI, 0.64-1.04, P = 0.10).
Conclusions: Our meta-analysis indicated that PMRT might reduce local-regional recurrence for ypN0 patients after NAC, but lake of benefit for survival outcomes. Prospective randomized clinical trial data will be needed to confirm our results.
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3