1Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
4Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
6Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
7Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
8Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
9Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
10Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
11Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea
12Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea
13Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea
Copyright © 2017 by the Korean Cancer Association
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Characteristic |
Before matching |
After matching |
||||
---|---|---|---|---|---|---|
WBI alone (n=783) | WBI+SCNRT (n=364) | p-value | WBI alone (n=271) | WBI+SCNRT (n=271) | p-value | |
Age (yr) | ||||||
≤ 40 | 151 (19.3) | 80 (21.9) | 0.29 | 47 (17.3) | 57 (21.1) | 0.27 |
> 40 | 632 (80.7) | 284 (78.1) | 224 (82.7) | 214 (78.9) | ||
Pathology | ||||||
IDC | 745 (95.1) | 333 (91.5) | 0.02 | 260 (95.9) | 254 (93.7) | 0.24 |
Non-IDC | 38 (4.9) | 31 (8.5) | 11 (4.1) | 17 (6.3) | ||
Tumor size (mm) | ||||||
≤ 20 | 406 (51.9) | 182 (50.0) | 0.56 | 127 (46.8) | 127 (46.8) | 1.00 |
> 20 | 377 (48.1) | 182 (50.0) | 144 (53.2) | 144 (53.2) | ||
T stage | ||||||
T1 | 397 (50.7) | 172 (47.3) | 0.32 | 125 (46.1) | 123 (45.4) | 0.99 |
T2 | 382 (48.8) | 188 (51.6) | 145 (53.5) | 147 (54.2) | ||
T3 | 4 (0.5) | 4 (1.1) | 1 (0.4) | 1 (0.4) | ||
No. of tumors | ||||||
Single | 652 (83.3) | 302 (82.9) | 0.89 | 226 (83.4) | 227 (83.7) | 0.91 |
Multiple | 131 (16.7) | 62 (17.1) | 45 (16.6) | 44 (16.3) | ||
LVI | ||||||
Negative | 368 (46.9) | 85 (23.4) | < 0.01 | 80 (29.5) | 80 (29.5) | 1.00 |
Positive | 415 (53.1) | 279 (76.6) | 191 (70.5) | 191 (70.5) | ||
HG | ||||||
1, 2 | 488 (62.3) | 225 (61.8) | 0.86 | 159 (58.7) | 159 (58.7) | 1.00 |
3 | 295 (37.7) | 139 (38.2) | 112 (41.3) | 112 (41.3) | ||
Molecular subtype | ||||||
Luminal A | 415 (53.1) | 180 (49.5) | 0.04 | 136 (50.1) | 125 (46.1) | 0.20 |
Luminal B | 127 (16.2) | 53 (14.6) | 46 (16.9) | 42 (15.5) | ||
Luminal-HER2 | 66 (8.4) | 51 (14.0) | 26 (9.6) | 39 (14.4) | ||
HER2 enriched | 51 (6.5) | 18 (4.9) | 24 (8.9) | 16 (5.9) | ||
Triple negative | 124 (15.8) | 62 (17.0) | 39 (14.5) | 49 (18.1) | ||
No. of positive nodes | ||||||
1 | 550 (70.2) | 118 (32.4) | < 0.01 | 114 (42.1) | 114 (42.1) | 1.00 |
2 | 161 (20.6) | 144 (39.6) | 97 (35.8) | 97 (35.8) | ||
3 | 72 (9.2) | 102 (28.0) | 60 (22.1) | 60 (22.1) | ||
No. of total LNs | ||||||
≤ 16 | 437 (55.8) | 210 (57.7) | 0.55 | 145 (53.5) | 144 (53.1) | 0.93 |
> 16 | 346 (44.2) | 154 (42.3) | 126 (46.5) | 127 (46.9) | ||
Ratio of LN (+)a) | ||||||
≤ 0.1 | 546 (69.7) | 147 (40.4) | < 0.01 | 128 (47.2) | 128 (47.2) | 1.00 |
> 0.1 | 237 (30.3) | 217 (59.6) | 143 (52.8) | 143 (52.8) | ||
Endocrine therapyb) | ||||||
Yes | 584 (96.1) | 257 (90.5) | < 0.01 | 197 (94.7) | 187 (90.7) | 0.12 |
No | 24 (3.9) | 27 (9.5) | 11 (5.3) | 19 (9.3) | ||
Anti-HER2 therapyc) | ||||||
Yes | 34 (29.1) | 11 (15.9) | 0.04 | 17 (34.0) | 11 (20.0) | 0.11 |
No | 83 (70.9) | 58 (84.1) | 33 (66.0) | 44 (80.0) |
Values are presented as number (%). WBI, whole-breast irradiation; SCNRT, supraclavicular radiotherapy; IDC, invasive ductal carcinoma; LVI, lymphovascular invasion; HG, histologic grade; HER-2, human epidermal growth factor receptor-2; LN, lymph node.
a) Ratio of positive LNs to total dissected LNs,
b) Endocrine therapy was administered to patients with hormone-responsive tumors, such as luminal A, luminal B, and luminal HER2. The value in parentheses represents the proportion of patients with hormone-responsive tumor,
c) The value in parentheses represents the proportion of patients with HER2-amplified tumor.
Sites of the first failure | WBI alone (n=271) | WBI+SCNRT (n=271) | p-value |
---|---|---|---|
Isolated loco-regional | 3 (1.1) | 6 (2.2) | 0.47 |
Local only | 2 (0.7) | 3 (1.1) | |
Regional onlya) | 1 (0.4) | 3 (1.1) | |
Distant only | 13 (4.8) | 10 (3.7) | |
Simultaneous loco-regional and distant | 5 (1.9) | 4 (1.5) | |
Regional and distant | 4 (1.5) | 4 (1.5) | |
Loco-regional and distant | 1 (0.4) | 0 (0.0) | |
Total | 21 (7.7) | 20 (7.4) |
Values are presented as number (%). WBI, whole-breast irradiation; SCNRT, supraclavicular radiotherapy.
a) Regional recurrence occurred in the axillary lymph node (n=1) in WBI alone and the internal mammary lymph node (n=3) in WBI+SCNRT. Supraclavicular lymph node failure was detected in three patients, two in WBI alone and one in WBI+SCNRT. All supraclavicular lymph node failures were found simultaneously with distant metastasis.
Characteristic |
5-Yr DFS (%) |
HR (95% CI) | ||
---|---|---|---|---|
WBI alone | WBI+SCNRT | p-valuea) | ||
Age (yr) | ||||
≤ 40 | 93.6 | 88.3 | 0.27 | 1.52 (0.45-5.21) |
> 40 | 94.5 | 94.3 | 1.13 (0.53-2.41) | |
Tumor size (mm) | ||||
≤ 20 | 96.0 | 96.1 | 0.15 | 1.03 (0.31-3.31) |
> 20 | 92.9 | 89.9 | 1.34 (0.63-2.89) | |
No. of tumors | ||||
Single | 94.1 | 92.4 | 0.46 | 1.29 (0.67-2.49) |
Multiple | 95.6 | 97.5 | 0.62 (0.04-6.01) | |
LVI | ||||
Negative | 96.2 | 97.1 | 0.09 | 0.32 (0.04-2.96) |
Positive | 93.6 | 91.5 | 1.45 (0.73-2.85) | |
HG | ||||
1, 2 | 96.1 | 96.3 | 0.06 | 0.79 (0.28-2.23) |
3 | 91.9 | 88.7 | 1.64 (0.71-3.78) | |
Molecular subtype | ||||
Luminal A | 97.0 | 96.2 | 0.17 | 0.98 (0.31-3.06) |
Non-luminal A | 91.7 | 90.5 | 1.31 (0.59-2.83) | |
No. of positive nodes | ||||
1, 2 | 95.2 | 93.5 | 0.64 | 1.51 (0.71-3.19) |
3 | 91.5 | 91.9 | 0.71 (0.20-2.51) | |
Ratio of LN (+)b) | ||||
≤ 0.1 | 96.8 | 95.4 | 0.06 | 1.29 (0.36-4.69) |
> 0.1 | 92.2 | 91.4 | 1.14 (0.55-2.38) |
DFS, disease-free survival; WBI, whole-breast irradiation; WBI+SCNRT, WBI with supraclavicular lymph node radiotherapy; HR, hazard ratio; CI, confidence interval; LVI, lymphovascular invasion; HG, histologic grade; LN, lymph node.
a) The logrank test was used to compare survival between groups,
b) Ratio of positive LNs to total dissected LNs.
Morbidity |
WBI alone (n=271) |
WBI+SCNRT (n=271) |
p-valuea) | ||||
---|---|---|---|---|---|---|---|
Grade 1 | Grade 2 | Total | Grade 1 | Grade 2 | Total | ||
Lymphedema | 23 (8.5) | 6 (2.2) | 29 (10.7) | 33 (12.2) | 12 (4.4) | 45 (16.6) | 0.04 |
Pneumonitis | 2 (0.7) | 0 | 2 (0.7) | 11 (4.1) | 0 | 11 (4.1) | 0.01 |
Study | Design | Years of accrual | No. of N1 patients | HTx (%) | CTx (%) | CTx agents | RT field | SCN failure (total/isolated) | Survival |
---|---|---|---|---|---|---|---|---|---|
Livi et al. [6] | Retrospective | 1980-2001 | 823 | 36a) | 21.8a) | Anthracycline-based (20%), CMF (65%), others (15%) | WBI | 0.9%/NR | NR |
Reddy et al. [7] | Retrospective | 1985-2002 | 202 | 66 | 72 | Anthracycline-based (57%), others (15%) | WBI | 2.0%/0.5% | SCNFFS: 97.9%, at 5 yr |
Truong et al. [11] | Retrospective | 1989-1999 | 1,255 | 64b) | 59.6b) | NR | WBI (n=817) | 2.2%/NR | LRRFS: 88.8% (WBI), 92.5% (WBI+SCNRT), at 10 yr |
WBI+SCNRT (n=438) | |||||||||
Yu et al. [9] | Retrospective | 1999-2003 | 448 | 61 | 98.9 | CMF (63%), AC (28%), FAC (8%) | WBI | 8.7%/1.8% | DMFS: 85.7%, SCNFFS: 92.6% at 5 yr |
Yates et al. [10] | Retrospective | 1975-2000 | 1,065 | 6-79c) | 24-49c) | CMF (74%), melphalan (17%), anthracycline (7%) | WBI | 9.2%/NR | SCNFFS: 93.0%, at 5 yr |
Whelan et al. [4, 15] | Prospective, randomized | 2000-2007 | 1,558 | 75.4d) | 90.5d) | Anthracycline (86%), AT (26%) | WBI (n=780) | NR | DFS: 87.0% vs. 92.4% |
WBI+RNI (n=778) | DMFS: 87.0% vs. 92.4%, at 5 yr | ||||||||
Poortmans et al.e) [3] | Prospective, randomized | 1996-2004 | 1,725 | 59.6e) | 54.7e) | NR | WBI or CWI (n=780) | NR | DFS: 69.1% vs. 79.1% |
WBI or CWI+RNI (n=778) | DMFS: 75.0% vs. 78.0%, at 10 yr | ||||||||
Current study | Retrospective, case-control | 2006-2010 | 542 | 92.8 | 100 | AT (100%) | WBI (n=271) | 0.7%/0.0% | DFS: 94.4% vs. 92.6% |
WBI+SCNRT (n=271) | 0.4%/0.0% | DMFS: 95.1% vs. 94.5%, at 5 yr |
SCN, supraclavicular lymph node; HTx, hormone therapy; CTx, chemotherapy; RT, radiotherapy; CMF, cyclophosphamide, methotrexate, and 5-fluorouracil; WBI, whole-breast irradiation; NR, not reported; SCNFFS, supraclavicular lymph node failure-free survival; SCNRT, supraclavicular radiotherapy; LRRFS, loco-regional recurrence-free survival; AC, adriamycin and cyclophosphamide; FAC, 5-fluorouracil, adriamycin, and cyclophosphamide; DMFS, distant metastasis failure-free survival; AT, anthracycline with taxane; RNI, regional-nodal irradiation (internal mammary, supraclavicular, and axillary lymph nodes); DFS, disease free survival; CWI, chest wall irradiation.
a) The study included 4,185 patients with N0 (68.6%), N1 (19.7%), N2 (9.3%), or unknown nodal status (2.4%) breast cancer. The proportions indicate the number of patients who underwent hormone therapy or chemotherapy among all patients,
b) There were 469 patients (37%) treated with hormone therapy alone, 408 patients (33%) treated with chemotherapy alone, and 340 patients (27%) treated with both hormone therapy and chemotherapy,
c) The proportion of patients receiving hormone therapy and chemotherapy increased with time. The rate of SCN failure steadily decreased over the same time period,
d) Proportion of patients receiving hormone therapy or chemotherapy relative to all patients with N0-N2 breast cancer. Survival was not specified solely for N1 cases,
e) The study included patients with N0-N3 breast cancer treated with breast-conserving surgery (76.1%) or mastectomy (23.9%). The proportion of patients treated with hormone therapy or chemotherapy was calculated among patients with N0-N3 disease. Survival was not specified solely for N1 cases.
Characteristic | Before matching |
After matching |
||||
---|---|---|---|---|---|---|
WBI alone (n=783) | WBI+SCNRT (n=364) | p-value | WBI alone (n=271) | WBI+SCNRT (n=271) | p-value | |
Age (yr) | ||||||
≤ 40 | 151 (19.3) | 80 (21.9) | 0.29 | 47 (17.3) | 57 (21.1) | 0.27 |
> 40 | 632 (80.7) | 284 (78.1) | 224 (82.7) | 214 (78.9) | ||
Pathology | ||||||
IDC | 745 (95.1) | 333 (91.5) | 0.02 | 260 (95.9) | 254 (93.7) | 0.24 |
Non-IDC | 38 (4.9) | 31 (8.5) | 11 (4.1) | 17 (6.3) | ||
Tumor size (mm) | ||||||
≤ 20 | 406 (51.9) | 182 (50.0) | 0.56 | 127 (46.8) | 127 (46.8) | 1.00 |
> 20 | 377 (48.1) | 182 (50.0) | 144 (53.2) | 144 (53.2) | ||
T stage | ||||||
T1 | 397 (50.7) | 172 (47.3) | 0.32 | 125 (46.1) | 123 (45.4) | 0.99 |
T2 | 382 (48.8) | 188 (51.6) | 145 (53.5) | 147 (54.2) | ||
T3 | 4 (0.5) | 4 (1.1) | 1 (0.4) | 1 (0.4) | ||
No. of tumors | ||||||
Single | 652 (83.3) | 302 (82.9) | 0.89 | 226 (83.4) | 227 (83.7) | 0.91 |
Multiple | 131 (16.7) | 62 (17.1) | 45 (16.6) | 44 (16.3) | ||
LVI | ||||||
Negative | 368 (46.9) | 85 (23.4) | < 0.01 | 80 (29.5) | 80 (29.5) | 1.00 |
Positive | 415 (53.1) | 279 (76.6) | 191 (70.5) | 191 (70.5) | ||
HG | ||||||
1, 2 | 488 (62.3) | 225 (61.8) | 0.86 | 159 (58.7) | 159 (58.7) | 1.00 |
3 | 295 (37.7) | 139 (38.2) | 112 (41.3) | 112 (41.3) | ||
Molecular subtype | ||||||
Luminal A | 415 (53.1) | 180 (49.5) | 0.04 | 136 (50.1) | 125 (46.1) | 0.20 |
Luminal B | 127 (16.2) | 53 (14.6) | 46 (16.9) | 42 (15.5) | ||
Luminal-HER2 | 66 (8.4) | 51 (14.0) | 26 (9.6) | 39 (14.4) | ||
HER2 enriched | 51 (6.5) | 18 (4.9) | 24 (8.9) | 16 (5.9) | ||
Triple negative | 124 (15.8) | 62 (17.0) | 39 (14.5) | 49 (18.1) | ||
No. of positive nodes | ||||||
1 | 550 (70.2) | 118 (32.4) | < 0.01 | 114 (42.1) | 114 (42.1) | 1.00 |
2 | 161 (20.6) | 144 (39.6) | 97 (35.8) | 97 (35.8) | ||
3 | 72 (9.2) | 102 (28.0) | 60 (22.1) | 60 (22.1) | ||
No. of total LNs | ||||||
≤ 16 | 437 (55.8) | 210 (57.7) | 0.55 | 145 (53.5) | 144 (53.1) | 0.93 |
> 16 | 346 (44.2) | 154 (42.3) | 126 (46.5) | 127 (46.9) | ||
Ratio of LN (+) |
||||||
≤ 0.1 | 546 (69.7) | 147 (40.4) | < 0.01 | 128 (47.2) | 128 (47.2) | 1.00 |
> 0.1 | 237 (30.3) | 217 (59.6) | 143 (52.8) | 143 (52.8) | ||
Endocrine therapy |
||||||
Yes | 584 (96.1) | 257 (90.5) | < 0.01 | 197 (94.7) | 187 (90.7) | 0.12 |
No | 24 (3.9) | 27 (9.5) | 11 (5.3) | 19 (9.3) | ||
Anti-HER2 therapy |
||||||
Yes | 34 (29.1) | 11 (15.9) | 0.04 | 17 (34.0) | 11 (20.0) | 0.11 |
No | 83 (70.9) | 58 (84.1) | 33 (66.0) | 44 (80.0) |
Sites of the first failure | WBI alone (n=271) | WBI+SCNRT (n=271) | p-value |
---|---|---|---|
Isolated loco-regional | 3 (1.1) | 6 (2.2) | 0.47 |
Local only | 2 (0.7) | 3 (1.1) | |
Regional only |
1 (0.4) | 3 (1.1) | |
Distant only | 13 (4.8) | 10 (3.7) | |
Simultaneous loco-regional and distant | 5 (1.9) | 4 (1.5) | |
Regional and distant | 4 (1.5) | 4 (1.5) | |
Loco-regional and distant | 1 (0.4) | 0 (0.0) | |
Total | 21 (7.7) | 20 (7.4) |
Characteristic | 5-Yr DFS (%) |
HR (95% CI) | ||
---|---|---|---|---|
WBI alone | WBI+SCNRT | p-value |
||
Age (yr) | ||||
≤ 40 | 93.6 | 88.3 | 0.27 | 1.52 (0.45-5.21) |
> 40 | 94.5 | 94.3 | 1.13 (0.53-2.41) | |
Tumor size (mm) | ||||
≤ 20 | 96.0 | 96.1 | 0.15 | 1.03 (0.31-3.31) |
> 20 | 92.9 | 89.9 | 1.34 (0.63-2.89) | |
No. of tumors | ||||
Single | 94.1 | 92.4 | 0.46 | 1.29 (0.67-2.49) |
Multiple | 95.6 | 97.5 | 0.62 (0.04-6.01) | |
LVI | ||||
Negative | 96.2 | 97.1 | 0.09 | 0.32 (0.04-2.96) |
Positive | 93.6 | 91.5 | 1.45 (0.73-2.85) | |
HG | ||||
1, 2 | 96.1 | 96.3 | 0.06 | 0.79 (0.28-2.23) |
3 | 91.9 | 88.7 | 1.64 (0.71-3.78) | |
Molecular subtype | ||||
Luminal A | 97.0 | 96.2 | 0.17 | 0.98 (0.31-3.06) |
Non-luminal A | 91.7 | 90.5 | 1.31 (0.59-2.83) | |
No. of positive nodes | ||||
1, 2 | 95.2 | 93.5 | 0.64 | 1.51 (0.71-3.19) |
3 | 91.5 | 91.9 | 0.71 (0.20-2.51) | |
Ratio of LN (+) |
||||
≤ 0.1 | 96.8 | 95.4 | 0.06 | 1.29 (0.36-4.69) |
> 0.1 | 92.2 | 91.4 | 1.14 (0.55-2.38) |
Morbidity | WBI alone (n=271) |
WBI+SCNRT (n=271) |
p-value |
||||
---|---|---|---|---|---|---|---|
Grade 1 | Grade 2 | Total | Grade 1 | Grade 2 | Total | ||
Lymphedema | 23 (8.5) | 6 (2.2) | 29 (10.7) | 33 (12.2) | 12 (4.4) | 45 (16.6) | 0.04 |
Pneumonitis | 2 (0.7) | 0 | 2 (0.7) | 11 (4.1) | 0 | 11 (4.1) | 0.01 |
Study | Design | Years of accrual | No. of N1 patients | HTx (%) | CTx (%) | CTx agents | RT field | SCN failure (total/isolated) | Survival |
---|---|---|---|---|---|---|---|---|---|
Livi et al. [6] | Retrospective | 1980-2001 | 823 | 36 |
21.8 |
Anthracycline-based (20%), CMF (65%), others (15%) | WBI | 0.9%/NR | NR |
Reddy et al. [7] | Retrospective | 1985-2002 | 202 | 66 | 72 | Anthracycline-based (57%), others (15%) | WBI | 2.0%/0.5% | SCNFFS: 97.9%, at 5 yr |
Truong et al. [11] | Retrospective | 1989-1999 | 1,255 | 64 |
59.6 |
NR | WBI (n=817) | 2.2%/NR | LRRFS: 88.8% (WBI), 92.5% (WBI+SCNRT), at 10 yr |
WBI+SCNRT (n=438) | |||||||||
Yu et al. [9] | Retrospective | 1999-2003 | 448 | 61 | 98.9 | CMF (63%), AC (28%), FAC (8%) | WBI | 8.7%/1.8% | DMFS: 85.7%, SCNFFS: 92.6% at 5 yr |
Yates et al. [10] | Retrospective | 1975-2000 | 1,065 | 6-79 |
24-49 |
CMF (74%), melphalan (17%), anthracycline (7%) | WBI | 9.2%/NR | SCNFFS: 93.0%, at 5 yr |
Whelan et al. [4, 15] | Prospective, randomized | 2000-2007 | 1,558 | 75.4 |
90.5 |
Anthracycline (86%), AT (26%) | WBI (n=780) | NR | DFS: 87.0% vs. 92.4% |
WBI+RNI (n=778) | DMFS: 87.0% vs. 92.4%, at 5 yr | ||||||||
Poortmans et al. |
Prospective, randomized | 1996-2004 | 1,725 | 59.6 |
54.7 |
NR | WBI or CWI (n=780) | NR | DFS: 69.1% vs. 79.1% |
WBI or CWI+RNI (n=778) | DMFS: 75.0% vs. 78.0%, at 10 yr | ||||||||
Current study | Retrospective, case-control | 2006-2010 | 542 | 92.8 | 100 | AT (100%) | WBI (n=271) | 0.7%/0.0% | DFS: 94.4% vs. 92.6% |
WBI+SCNRT (n=271) | 0.4%/0.0% | DMFS: 95.1% vs. 94.5%, at 5 yr |
Values are presented as number (%). WBI, whole-breast irradiation; SCNRT, supraclavicular radiotherapy; IDC, invasive ductal carcinoma; LVI, lymphovascular invasion; HG, histologic grade; HER-2, human epidermal growth factor receptor-2; LN, lymph node. Ratio of positive LNs to total dissected LNs, Endocrine therapy was administered to patients with hormone-responsive tumors, such as luminal A, luminal B, and luminal HER2. The value in parentheses represents the proportion of patients with hormone-responsive tumor, The value in parentheses represents the proportion of patients with HER2-amplified tumor.
Values are presented as number (%). WBI, whole-breast irradiation; SCNRT, supraclavicular radiotherapy. Regional recurrence occurred in the axillary lymph node (n=1) in WBI alone and the internal mammary lymph node (n=3) in WBI+SCNRT. Supraclavicular lymph node failure was detected in three patients, two in WBI alone and one in WBI+SCNRT. All supraclavicular lymph node failures were found simultaneously with distant metastasis.
DFS, disease-free survival; WBI, whole-breast irradiation; WBI+SCNRT, WBI with supraclavicular lymph node radiotherapy; HR, hazard ratio; CI, confidence interval; LVI, lymphovascular invasion; HG, histologic grade; LN, lymph node. The logrank test was used to compare survival between groups, Ratio of positive LNs to total dissected LNs.
Values are presented as number (%). WBI, whole-breast irradiation; SCNRT, supraclavicular radiotherapy. p-values were calculated by Fisher exact test to compare the proportion of patients with complication of grade 1 or higher between groups.
SCN, supraclavicular lymph node; HTx, hormone therapy; CTx, chemotherapy; RT, radiotherapy; CMF, cyclophosphamide, methotrexate, and 5-fluorouracil; WBI, whole-breast irradiation; NR, not reported; SCNFFS, supraclavicular lymph node failure-free survival; SCNRT, supraclavicular radiotherapy; LRRFS, loco-regional recurrence-free survival; AC, adriamycin and cyclophosphamide; FAC, 5-fluorouracil, adriamycin, and cyclophosphamide; DMFS, distant metastasis failure-free survival; AT, anthracycline with taxane; RNI, regional-nodal irradiation (internal mammary, supraclavicular, and axillary lymph nodes); DFS, disease free survival; CWI, chest wall irradiation. The study included 4,185 patients with N0 (68.6%), N1 (19.7%), N2 (9.3%), or unknown nodal status (2.4%) breast cancer. The proportions indicate the number of patients who underwent hormone therapy or chemotherapy among all patients, There were 469 patients (37%) treated with hormone therapy alone, 408 patients (33%) treated with chemotherapy alone, and 340 patients (27%) treated with both hormone therapy and chemotherapy, The proportion of patients receiving hormone therapy and chemotherapy increased with time. The rate of SCN failure steadily decreased over the same time period, Proportion of patients receiving hormone therapy or chemotherapy relative to all patients with N0-N2 breast cancer. Survival was not specified solely for N1 cases, The study included patients with N0-N3 breast cancer treated with breast-conserving surgery (76.1%) or mastectomy (23.9%). The proportion of patients treated with hormone therapy or chemotherapy was calculated among patients with N0-N3 disease. Survival was not specified solely for N1 cases.