Do T1a breast cancers profit from adjuvant systemic therapy? A multicenter retrospective cohort study of 325 T1a-patients

Wolters, Regine; Ebner, Florian; Janni, Wolfgang; Novopashenny, I.; Wöckel, Achim; Wischnewsky, Manfred; Schwentner, Lukas

doi:10.1007/s00404-016-4016-y

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…This is in line with the results previously described by the BRENDA study group and published by Wolters et al [10] . There, pT1a patients with infiltration of lymph nodes who received AST showed improved RFS and OAS due to AST.…”

Section: Discussionsupporting

confidence: 83%

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Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

Stüber

Novopashenny²,

Diessner³

et al. 2017

Oncology

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Objective: To identify subgroups of patients with pT1 pN0 breast cancer (BC) who might not profit from adjuvant systemic therapy (AST). Methods: Data of 3,774 pT1 pN0 BC patients from 17 certified BC centres within the BRENDA study group were collected between 1992 and 2008 and retrospectively analysed. Uni- and multivariate analyses were performed using Kaplan-Meier methods and Cox regression models. Results: 279 (7.4%) of the pT1 pN0 BC patients were T1a, 944 (25.0%) were T1b and 2,551 (67.6%) were T1c. There was no significant difference (p > 0.1) in recurrence-free survival (RFS)/overall survival (OAS) between patients with pT1a, pT1b, and T1c. Patients receiving any type of AST had a better outcome compared to women without AST after adjusting for age, tumour size, and intrinsic subtypes (RFS: p < 0.001; OAS: p < 0.001). AST was the most important prognostic parameter for RFS followed by intrinsic subtypes and age. Conclusion: Patients with pT1 pN0 BC profit from AST independently of molecular subtypes, tumour size, age or comorbidity, with 5-year RFS of more than 95%. The correct definition of subgroups of patients who do not need AST is still an open question.

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Section: Discussionsupporting

confidence: 83%

“…We therefore avoid the term "statistically significant." Statistical analyses were carried out with SPSS (22) and NCSS (10).…”

Section: Statisticsmentioning

confidence: 99%

Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

Stüber

Novopashenny²,

Diessner³

et al. 2017

Oncology

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“…In Ignatov et al's study of 919 patients with T1a,b breast cancer, chemotherapy with trastuzumab was associated with a significant increase in 5‐year survival from 81% to 96% in patients with HER2 + tumors which constituted 20% of the study cohort . Similarly, Wolters et al demonstrated a significant survival benefit to chemotherapy for HER2 + T1a,b tumors. However, these two studies included patients with node‐positive disease.…”

Section: Discussionmentioning

confidence: 95%

Outcomes in patients with small node‐negative invasive breast cancer

et al. 2019

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Purpose There is controversy whether systemic therapy is warranted in patients with small node‐negative tumors, especially among those with HER2+ and triple negative breast cancers (TNBC). In this study we sought to compare survival and recurrence rates (RR) in patients with T1mi,a,bN0M0 breast cancer by tumor type. Methods Review of a prospectively maintained data base between January 1, 2000 through December 31, 2013 identified 71 patients with HER2+ tumors, 545 with hormone receptor (HR)+/HER2− tumors, and 45 with TNBC. The three groups were compared with respect to RR, disease‐free survival (DFS), and overall survival (OS). Patients with HER2+ disease and TNBC who received chemotherapy were compared to those who did not. Results At mean follow‐up of 4.9 years, the 5‐year OS was 95% and 5‐year DFS was 98%. RR for HER2+, HR+/HER2−, and TNBC was 7.0%, 3.7%, and 4.4% respectively (P = 0.2). There was no significant difference in OS (P = 0.9) and DFS (P = 0.4) amongst the three groups. On multivariable analysis, use of adjuvant chemotherapy was not associated with improvement in DFS or OS. When patients with HER2+ breast cancer and TNBC who received chemotherapy were compared to those who did not, there was no difference in death rates (P = 0.3). Conclusions Patients with T1mi,a,bN0M0 invasive breast cancer have an excellent prognosis. The three molecular subtypes differed significantly in age, tumor size, and tumor grade, but had similar RR, DFS, and OS. Chemotherapy was not associated with improved survival. Tumor subtype may not influence recurrence and survival in such small early stage tumors.

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“…The comprehensive BRENDA database with a large number of patients and a long follow up provided by a network of 17 certified breast cancer centers with information on treatment and survival, annual audits for the data quality has provided valuable data for healthcare research [6, 10, 11, 13–16, 45]. The follow up was done according to the German breast cancer guidelines [1].…”

Section: Discussionmentioning

confidence: 99%

Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival?

Ebner

Wöckel

Schwentner³

et al. 2019

BMC Cancer

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BackgroundThe decision making process for axillary dissection has changed in recent years for patients with early breast cancer and positive sentinel lymph nodes (LN). The question now arises, what is the optimal surgical treatment for patients with positive axillary LN (pN+). This article tries to answer the following questions:Is there a survival benefit for breast cancer patients with 3 or more positive LN (pN3+) and with more than 10 removed LN?Is there a survival benefit for high risk breast cancer patients (triple negative or Her2 + breast cancer) and with 3 or more positive LN (pN3+) with more than 10 removed LN?In pN + patients is the prognostic value of the lymph node ratio (LNR) of pN+/pN removed impaired if 10 or less LN are removed?MethodsA retrospective database analysis of the multi center cohort database BRENDA (breast cancer under evidence based guidelines) with data from 9625 patients from 17 breast centers was carried out. Guideline adherence was defined by the 2008 German National consensus guidelines.Results2992 out of 9625 patients had histological confirmed positive lymph nodes. The most important factors for survival were intrinsic sub types, tumor size and guideline adherent chemo- and hormonal treatment (and age at diagnosis for overall survival (OAS)). Uni-and multivariable analyses for recurrence free survival (RFS) and OAS showed no significant survival benefit when removing more than 10 lymph nodes even for high-risk patients. The mean and median of LNR were significantly higher in the pN+ patients with ≤10 excised LN compared to patients with > 10 excised LN. LNR was in both, uni-and multivariable, analysis a highly significant prognostic factor for RFS and OAS in both subgroups of pN + patients with less respective more than 10 excised LN. Multivariable COX regression analysis was adjusted by age, tumor size, intrinsic sub types and guideline adherent adjuvant systemic therapy.ConclusionThe removal of more than 10 LN did not result in a significant survival benefit even in high risk pN + breast cancer patients.

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Do T1a breast cancers profit from adjuvant systemic therapy? A multicenter retrospective cohort study of 325 T1a-patients

Abstract: There is an association between AST and improved RFS or OAS for breast cancer patients with T1a tumors.

Cited by 9 publications

References 24 publications

Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

Outcomes in patients with small node‐negative invasive breast cancer

Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival?

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