Breast cancer presenting with intravascular tumor emboli in axillary soft tissue: Recurrence risk and radiation therapy outcomes Journal Article
| Authors: | Sarkar, R. R.; Lavery, J. A.; Zhang, Z.; Mueller, B. A.; Zinovoy, M.; Cuaron, J. J.; McCormick, B.; Khan, A. J.; Powell, S. N.; Wen, H. Y.; Braunstein, L. Z. |
| Article Title: | Breast cancer presenting with intravascular tumor emboli in axillary soft tissue: Recurrence risk and radiation therapy outcomes |
| Abstract: | Purpose: Intravascular tumor emboli in axillary soft tissue (ITE) is a rare pathologic finding in breast cancer and is associated with higher axillary nodal disease burden. The independent prognostic and predictive value of this entity is unknown, as is the role of radiation therapy for ITE. Methods and Materials: We analyzed a prospectively maintained database of breast cancer patients treated from 1992 to 2020. Patients with ITE were matched to those without (1:2) based on propensity scores to control for potential confounding factors. Locoregional (LRR) and distant recurrence (DR) were evaluated using competing risks methods accounting for death as a competing event. Overall survival (OS) and disease-free survival (DFS) were evaluated by Cox regression models. Among patients with ITE, we also evaluated whether RT improved outcomes. Results: Among 2377 total patients, 129 had ITE, of whom 126 were propensity score matched to 252 without ITE. Median follow-up from time of surgery was 5.5 years (IQR 2.3, 9.7). There were no statistically significant differences in the 5-year incidence of LRR between groups (5.4% [95% CI, 1.6%-13%] with ITE vs 10% [95% CI, 6.7%-15%] without, P = .53) or DR (24% [95% CI, 15% 35%] with ITE vs 21% [95% CI, 16%-27%] without, P = .51). Five-year OS and DFS did not differ between groups (P > .9 for both comparisons, patients with ITE vs without ITE). In analyzing the effect of RT among patients with ITE, receipt of RT was associated with significantly improved DFS (HR, 0.34, 95% CI, 0.12-0.93, P = .04). Conclusions: Patients with ITE do not exhibit significantly worse LRR, DR, DFS, or OS compared with a propensity-score-matched cohort without ITE. However, among patients with ITE, those who received RT demonstrated significantly improved DFS. Larger studies with longer follow-up are needed to evaluate the prognostic and predictive implications of ITE. © 2024 The Author(s) |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; major clinical study; overall survival; cancer recurrence; cancer patient; cancer radiotherapy; comparative study; disease free survival; recurrence risk; follow up; antineoplastic agent; mastectomy; cohort analysis; data base; soft tissue; proportional hazards model; death; recurrent disease; fisher exact test; tumor embolism; rank sum test; predictive value; cumulative incidence; breast-conserving surgery; confounding variable; propensity score; cancer prognosis; invasive breast cancer; human; female; article |
| Journal Title: | Advances in Radiation Oncology |
| Volume: | 9 |
| Issue: | 7 |
| ISSN: | 2452-1094 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-06-30 |
| Start Page: | 101508 |
| Language: | English |
| DOI: | 10.1016/j.adro.2024.101508 |
| PROVIDER: | scopus |
| PMCID: | PMC11127195 |
| PUBMED: | 38799109 |
| DOI/URL: | |
| Notes: | Article -- MSKC Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Lior Braunstein -- Source: Scopus |
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