Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study

Herr, D.; Wischnewsky, Manfred; Joukhadar, Ralf; Chow, Olivia; Leinert, Elena; Fink, Visnja; Stüber, Tanja; Curtaz, Carolin; Blettner, Maria; Wollschläger, Daniel; Wöckel, Achim

doi:10.1371/journal.pone.0218434

Cited by 19 publications

(19 citation statements)

References 35 publications

(40 reference statements)

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“…In a high-risk luminal A, however, 30-50% of patients relapse and develop distant metastasis particularly in cases with node-positive tumors and younger patients [46]. Some retrospective studies reported that standard anthracycline-based chemotherapy was not effective in luminal A-subtype [47][48][49]. However, chemotherapy showed some benefits in high-risk luminal subtypes particularly with positive lymph nodes [47].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

et al. 2020

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Background: More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages. Methods: Breast cancer patients (n = 1304) admitted to our institute (2014-2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years. Results: Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544-2.898) particularly in the luminal Alike subtype (OR 2.685, 95% CI 1.649-4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319-2.611), and the risk was higher in the Luminal Alike subtype (OR 2.572, 95% CI 1.547-4.278). Luminal Alike subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106-2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355-0.766) and the effect was stronger in Luminal Alike subtype (OR 0.417, 95% CI 0.226-0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209-2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003-2.083).

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Section: Discussionmentioning

confidence: 99%

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

et al. 2020

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“…For example, in patients who have favorable tumor characteristics (ER-positive/PR-positive, HER2-negative, and without nodal involvement) who met established guidelines for the recommendation of chemotherapy, those with favorable gene-expression profile may benefit from endocrine therapy alone 33 . Herr et al, found that chemotherapy did not improve survival Continued www.nature.com/scientificreports www.nature.com/scientificreports/ in patients with luminal A subtype, who had tumor size >20 mm and >3 positive nodes 34 . We observed that the survival benefit of starting recommended chemotherapy was more pronounced in patients with luminal A and basal proxy subtypes and starting recommended radiotherapy has the largest survival benefit in luminal B [HER2-positive] patients.…”

Section: Treatment Compliance and Overall Survival The High Mortalitmentioning

confidence: 99%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

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Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80-2.83]), chemotherapy (1.25 [1.11-1.41]), radiotherapy (2.28 [1.94-2.69]) and endocrine therapy (1.70 [1.41-2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations. Breast cancer is the leading type of cancer among Asian women, with an increasing number of cases diagnosed every year 1. Between 2003 and 2008, there were more than 2 million women living with breast cancer in SouthEast Asia, where a population of over 650 million women resides 2. As breast cancer is common, the number of lives claimed by the disease is high. On average ~100,000 deaths from breast cancer were recorded every year in the same region 3. With significant progress in treatment and disease management, a growing number of women are surviving breast cancer 4. However, breast cancer survival can vary between countries. While 90% of patients in the United States live at least five years after the cancer is found 5 , the corresponding proportion is lower in SouthEast Asia. In a report by Bhoo-Pathy et al., five-year overall survival rates were estimated to range from 58.5% to 75.8% in SouthEast Asia 6. Several professional organizations and consensus groups exist to translate evidence-based medicine into recommendations for best patient care 7. Examples of providers of such clinical practice guidelines include the

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“…1). We read the full text of 17 articles and finally included six articles [10,[16][17][18][19][20]. Table 1 shows the details of these publications.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

2020

World J Surg Onc

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Objective To assess the association between chemotherapy and prognosis of patients with breast cancer of luminal A subtype and lymph node-positive, luminal A subtype breast cancer Methods Articles published between January 1, 2010, and May 1, 2020, were collected from PubMed, Embase, and Web of Science databases. On the basis of a test for heterogeneity, we selected the random effects model or fixed effects model for meta-analysis. Article quality was evaluated by sensitivity analysis, and Begg’s and Egger’s tests were used to measure publication bias. Results Six eligible articles were identified. The hazard ratio of overall survival of luminal A breast cancer patients who received both chemotherapy and endocrine therapy was 1.73 (95% CI 1.23, 2.43). The hazard ratio of overall survival for lymph node-positive, luminal A breast cancer patients who received chemotherapy and endocrine therapy was 1.86 and 95% CI 1.26, 2.81. The hazard ratio of relapse-free survival to disease-free survival was 1.30 (95% CI 0.85, 1.77). Tumor size, vascular invasion, and age did not show significant correlations with breast cancer prognosis. Conclusion Compared with endocrine therapy alone, the addition of chemotherapy did not improve the prognosis of patients with luminal type A and lymph node positive cancer; instead, side effects of the additional chemotherapy may have negatively affected prognosis. Prospective studies are needed to determine whether the number of positive lymph nodes also correlates with efficacy of chemotherapy of luminal type A breast cancer.

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Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study

Cited by 19 publications

References 35 publications

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

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