Breast density reduction as a predictor for prognosis in premenopausal women with estrogen receptor-positive breast cancer: an exploratory analysis of the updated ASTRRA study-Reference-Cited by-同舟云学术

Breast density reduction as a predictor for prognosis in premenopausal women with estrogen receptor-positive breast cancer: an exploratory analysis of the updated ASTRRA study

Published:2023-11-23 Issue: Volume: Page:
ISSN:1743-9159
Container-title:International Journal of Surgery
language:en
Short-container-title:

Author:

Bae Soong June¹²,Kim Hee Jeong³,Kim Hyun-Ah⁴,Ryu Jai Min⁵,Park Seho⁶,Lee Eun-Gyeong⁷,Im Seock-Ah⁸,Jung Yongsik⁹,Park Min Ho¹⁰,Park Kyong Hwa¹¹,Kang Su Hwan¹²,Park Eunhwa¹³,Kim Sung Yong¹⁴,Lee Min Hyuk¹⁵,Kim Lee Su¹⁶,Lee Anbok¹⁶,Noh Woo Chul¹⁷,Gwark Sungchan¹⁸,Kim Seonok¹⁹,Jeong Joon¹²

Affiliation:

1. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

2. Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, South Korea

3. Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

4. Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea

5. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

6. Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea

7. Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea

8. Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, South Korea

9. Department of Surgery, Ajou University, School of Medicine, Suwon, South Korea

10. Department of Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Gwangju, South Korea

11. Korea University Anam Hospital, Department of internal medicine, Division of Medical Oncology/Hematology, Seoul, South Korea

12. Yeungnam University College of Medicine, Daegu, South Korea

13. Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea

14. Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea

15. Department of Surgery, Soonchunhyang University Hospital, Seoul, South Korea

16. Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

17. Department of Surgery, Konkuk Universitiy Medical Center, Seoul, South Korea

18. Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea

19. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea

Abstract

Background: While the relationship between mammographic breast density reduction (MDR) and endocrine therapy efficacy has been reported in estrogen receptor-positive breast cancer, it is still unclear in premenopausal women, especially in the case of adding ovarian function suppression (OFS) to anti-hormone therapy. We investigated the impact of MDR on prognosis stratified by treatment based on the updated results of the ASTRRA trial. Materials and Methods: The ASTRRA trial, a randomized phase III study, showed that adding OFS to tamoxifen (TAM) improved survival in premenopausal women with estrogen receptor (ER)-positive breast cancer after chemotherapy. We updated survival outcomes and assessed mammography before treatment and the annual follow-up mammography for up to 5 years after treatment initiation. Mammographic density (MD) was classified into four categories based on the Breast Imaging Reporting and Data System. MDR-positivity was defined as a downgrade in MD grade on follow-up mammography up to 2 years after randomization, with pretreatment MD grade as a reference. Results: We evaluated MDR in 944 of the 1282 patients from the trial, and 813 (86.2%) had grade III or IV MD. There was no difference in the MDR-positivity rate between the two treatment groups (TAM-only group (106/476 [22.3%]) vs. TAM+OFS group (89/468 [19.0%]); P=0.217). MDR-positivity was significantly associated with better disease-free survival (DFS) in the TAM+OFS group (estimated 8-year DFS: 93.1% in MDR-positive vs. 82.0% in MDR-negative patients; HR:0.37; 95% CI:0.16-0.85; P=0.019), but not in the TAM-only group (P interaction=0.039). MDR-positive patients who received TAM+OFS had a favorable DFS compared to MDR-negative patients who received only TAM (HR:0.30; 95% CI:0.13-0.70; P=0.005). Conclusion: Although the proportion of MDR-positive patients was comparable between both treatment groups, MDR-positivity was independently associated with favorable outcomes only in the TAM+OFS group.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine,Surgery