Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study

Gonçalvès, Anthony; Zemmour, Christophe; Cohen, Monique; Classe, Jean Marc; Reyal, Fabien; Colombo, Pierre; Jouve, Eva; Giard, S.; Barranger, Emmanuel; Sabatier, Renaud; Bertucci, François; Boher, Jean-Marie; Nonneville, Alexandre de

doi:10.1016/j.ejca.2017.06.043

Cited by 29 publications

(34 citation statements)

References 62 publications

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“…After having matched and considered confounding factors, including age, race, marital status, histological grade, surgery type, and radiotherapy, no striking difference in survival outcome was observed between the two groups of patients. Our result is in accordance with a previous study that found patients with subcentimetric tumors, including T1a and T1b, node-negative TNBC, receiving ACT did not derive a significant DFS or distance metastasis free survival (DMFS) benefit (15). Furthermore, in our study, the 3-and 5-year BCSS of the patients in the ACT group are both 98.5% after PSM with the value up to 98.9 and 98.1%, respectively, in the opposite group.…”

Section: Discussionsupporting

confidence: 93%

“…Given the lack of evidence, there is still controversy about whether or not to use ACT in patients with T1aN0M0 TNBC. Several retrospective studies state the relationship between disease-free survival (DFS) or OS advantage and chemotherapy in subcentimetric, node-negative TNBC (11,(14)(15)(16). Regretfully, the data related to T1a TNBC is limited.…”

Section: Introductionmentioning

confidence: 99%

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The Survival Outcomes of T1aN0M0 Triple-Negative Breast Cancer With Adjuvant Chemotherapy

Chen

Wang

et al. 2020

Front. Oncol.

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Triple-negative breast cancer (TNBC) is a subtype with distinct heterogeneity, high invasiveness, and poorer prognosis. There is a controversy about adjuvant chemotherapy (ACT) at the T1aN0M0 stage. This study was carried out to assess the survival benefit of ACT for these patients. Methods: We identified 1,099 patients with T1aN0M0 TNBC who were diagnosed between 2010 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariable analyses were conducted to determine factors related to survival. One-to-one (1:1) propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of ACT and non-ACT subjects. Breast cancer-specific survival (BCSS) and overall survival (OS) of the two groups were evaluated by Kaplan-Meier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed. Results: No obvious differences in demographic or clinical characteristics were found between patients who had ACT and those without ACT therapy in terms of race, marital status, laterality, or radiation therapy. A higher proportion of patients who were older, had a higher histological grade tumor, and who received breast-conserving surgery had adjuvant chemotherapy. The ACT group did not exhibit better survival in BCSS or OS before PSM. After PSM, the ACT and non-ACT groups consisted of 255 patients, respectively, and Kaplan-Meier curves and multivariate analysis both indicate that adjuvant chemotherapy was not associated with better survival in terms of BCSS or OS. Furthermore, we did not observe any survival advantage in any subgroup irrespective of age, race, marital status, histological grade, surgery type, or radiotherapy status. Conclusions: The study results indicate that there is no strong association between ACT and better survival in T1aN0M0 TNBC. It implies that the chemotherapy decision should be made cautiously and further research into therapeutic strategies are needed in T1aN0M0 TNBC patients.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Survival Outcomes of T1aN0M0 Triple-Negative Breast Cancer With Adjuvant Chemotherapy

Chen

Wang

et al. 2020

Front. Oncol.

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“…By this procedure, we found that although OCD in the chemotherapy cohort was lower than that in the no-chemotherapy cohort, there was no difference in BCSD between the two cohorts. Patients who had received chemotherapy had some unfavorable pathophysiological features, such as higher tumor grade and younger age, which were consistent with previous studies [17,18]. Hence, the discrepancy of OCD between two groups may partially be explained by a higher proportion of patients with older age and unmarried status in the no-chemotherapy cohort, and some potential comorbidities unavailable in the SEER database [12,19,20].…”

Section: Discussionsupporting

confidence: 86%

“…Another retrospective study, which included 82 TNBC cases (some of them were positive node), suggested that there was a tendency for OS benefit from chemotherapy for these specific patients [24]. Chemotherapy failed to provide any benefits for locoregional recurrence-free survival, metastasis-free survival, and DFS in two retrospective studies, including 174 T1a/b TNBC and 278 T1a/b TNBC patients, respectively [17,18]. Furthermore, Ren et al observed improved recurrence-free survival from chemotherapy in T1c TNBC but not in T1b [7].…”

Section: Discussionmentioning

confidence: 99%

“…There were several retrospective studies concentrating on the small TNBC because of the exclusion of these patients in most prospective randomized clinical trials. Almost all previous researches have focused on T1 (T1a/b, T1b/c, T1a/b/c) TNBC [7,17,[22][23][24]. One recent study (including 45 TNBC) by Jean et al revealed that chemotherapy was not associated with OS and disease-free survival (DFS) in patients with ≤ 1cm node-negative TNBC [23].…”

Section: Discussionmentioning

confidence: 99%

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The role of chemotherapy in patients with T1bN0M0 triple-negative breast cancer: a real-world competing risk analysis

Lan¹,

Lu²,

Luo³

et al. 2021

J. Cancer

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The objective of the present study was to implement Kaplan-Meier analysis, competing risk analysis, and propensity score matching to evaluate whether the patients with T1bN0M0 triple-negative breast (TNBC) could benefit from adjuvant chemotherapy. A total of 1849 patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All eligible patients were divided into two cohorts, the chemotherapy (1155 patients) and the no-chemotherapy (694 patients) cohorts. Similar 5-year breast cancer-specific survival (BCSS) was observed in the chemotherapy and no-chemotherapy cohorts (96.1% vs. 96.0%, p=0.820). The results of the competing risk analysis showed a comparable 5-year breast cancer-specific death (BCSD) in both groups (chemotherapy 3.6% vs. no-chemotherapy 3.4%, p=0.778). Also, a higher 5-year other causes death (OCD) was observed in the no-chemotherapy cohort (0.7% vs. 5.4%, p<0.001). Multivariable competing risks regression models showed no association between chemotherapy and BCSS (HR, 1.21; 95%CI, 0.64-2.31; p=0.560). After 1:1 PSM, no significant difference was also observed for BCSD and OCD between two cohorts. The value of adjuvant chemotherapy in patients with T1bN0M0 TNBC is less than the present guidelines recommend, suggesting that de-escalated treatment could be a potentially beneficial strategy in appropriately selected patients.

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Evaluation of Adjuvant Treatments for T1 N0 M0 Triple-Negative Breast Cancer

et al. 2020

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IMPORTANCE Adjuvant chemotherapy remains the only recommended treatment for patients with triple-negative breast cancer (TNBC). However, the existing evidence is not enough to recommend adjuvant therapies to patients with T1 N0 M0 TNBC. OBJECTIVE To evaluate the association of different adjuvant therapies with survival outcome in patients with T1 N0 M0 TNBC stratified by cancer stage and age. DESIGN, SETTING, AND PARTICIPANTS Postoperative patients diagnosed as having T1 N0 M0 TNBC between 2010 and 2015 who were enrolled in the Surveillance, Epidemiology, and End Results cancer registry program were included in this population-based cohort study. Data analysis was performed from March 27, 2019, to August 10, 2020. EXPOSURES Chemotherapy and radiotherapy. MAIN OUTCOMES AND MEASURES Kaplan-Meier curve and univariate and multivariable Cox proportional hazards regression analyses were performed to compare overall survival (OS) and breast cancer-specific survival (BCSS) between the different treatments. RESULTS A cohort of 7739 eligible patients (mean [SD] age, 59.5 [12.4] years; all female) were included in the present study. The 5-year OS of the total patients was 91.7% (95% CI, 90.9%-92.5%), and median follow-up was 45 months (95% CI, 44-46 months). Patients aged 70 years and older or with T1a TNBC were more likely to receive adjuvant radiotherapy than chemotherapy. Although any adjuvant therapy could improve OS in T1 N0 M0 TNBC, only chemotherapy was associated with significantly better breast cancer-specific survival (BCSS adjusted hazard ratio: 0.657; 95% CI, 0.460-0.939; P = .02). Adjuvant radiotherapy after breast-conserving surgery was associated with better OS and BCSS in patients aged 70 years and older but not in those younger than 70 years. For patients with T1c BC, chemotherapy after breast-conserving surgery or other surgery was associated with improved OS, whereas only chemotherapy after other surgery was associated with better BCSS. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that adjuvant therapies could improve OS in patients with T1 N0 M0 TNBC, whereas only chemotherapy was associated with better BCSS. Older patients with early-stage TNBC may benefit from adjuvant radiotherapy. Administration of adjuvant therapies to patients with different ages and cancer stages should be discussed carefully, which necessitates guidance from updated guidelines.

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Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study

Cited by 29 publications

References 62 publications

The Survival Outcomes of T1aN0M0 Triple-Negative Breast Cancer With Adjuvant Chemotherapy

The Survival Outcomes of T1aN0M0 Triple-Negative Breast Cancer With Adjuvant Chemotherapy

The role of chemotherapy in patients with T1bN0M0 triple-negative breast cancer: a real-world competing risk analysis

Evaluation of Adjuvant Treatments for T1 N0 M0 Triple-Negative Breast Cancer

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