• Ir J Med Sci · Dec 2024

    Review Meta Analysis

    Risk of locoregional recurrence after breast cancer surgery by molecular subtype-a systematic review and network meta-analysis.

    • Lily Nolan, Matthew G Davey, Gavin G Calpin, Éanna J Ryan, and Michael R Boland.
    • Discipline of Surgery, University of Galway, Newcastle Road, Galway, H91YR71, Ireland. lilynolan97@gmail.com.
    • Ir J Med Sci. 2024 Dec 1; 193 (6): 296529742965-2974.

    BackgroundThe prevention of locoregional recurrence (LRR) is crucial in breast cancer, as it translates directly into reduced breast cancer-related death. Breast cancer is subclassified into distinct intrinsic biological subtypes with varying clinical outcomes.AimsTo perform a systematic review and network meta-analysis (NMA) to determine the rate of LRR by breast cancer molecular subtype.MethodsA NMA was performed as per PRISMA-NMA guidelines. Molecular subtypes were classified by St Gallen expert consensus statement (2013). Analysis was performed using R and Shiny.ResultsFive studies were included including 6731 patients whose molecular subtypes were available. Overall, 47.3% (3182/6731) were Luminal A (LABC: estrogen receptor (ER) + /human epidermal growth factor receptor-2 (HER2) - /progesterone receptor (PR) + or Ki-67 < 20%), 25.5% (1719/6731) were Luminal B (LBBC: ER + /HER2 - /PR - or Ki-67 ≥ 20%), 11.2% (753/6731) were Luminal B-HER2 + (LBBC-HER2: ER + /HER2 +), 6.9% (466/6731) were HER2 + (HER2 ER - /HER2 +), and finally 9.1% (611/6731) were triple-negative breast cancer (TNBC: ER - /HER2 -). The median follow-up was 74.0 months and the overall LRR rate was 4.0% (271/6731). The LRR was 1.7% for LABC (55/3182), 5.1% for LBBC (88/1719), 6.0% for LBBC-HER2 (45/753), 6.0% for HER2 (28/466), and 7.9% for TNBC (48/611). At NMA, patients with TNBC (odds ratio (OR) 3.73, 95% confidence interval (CI) 1.80-7.74), HER2 (OR 3.24, 95% CI 1.50-6.99), LBBC-HER2 (OR 2.38, 95% CI 1.09-5.20), and LBBC (OR 2.20, 95% CI 1.07-4.50) were significantly more likely to develop LRR compared to LABC.ConclusionTNBC and HER2 subtypes are associated with the highest risk of LRR. Multidisciplinary team discussions should consider these findings to optimize locoregional control following breast cancer surgery.© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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