Effects of adjuvant chemotherapy in T1N0M0 triple-negative breast cancer

Ren, Yi; Hao, Shuang; Jin, Xi; Ye, Fu Gui; Gong, Yue; Jiang, Yi

doi:10.1016/j.breast.2018.11.011

Cited by 27 publications

(34 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One of the limitations of our study was that there were few TNBC patients in T 1b N 0 M 0 , and whether these patients need adjuvant CT after surgery is still controversial [28][29][30] ; thus, we were unable to carry out in-depth survival analysis and prognosis prediction for the T 1b N 0 M 0 group, nor can we guide clinical practice. Besides, neoadjuvant therapy is becoming an option for more and more TNBC patients, which was not included in our study.…”

Section: Discussionmentioning

confidence: 92%

The prognostic and predictive potential of Ki-67 in triple-negative breast cancer

Zhu

Chen

Huang

et al. 2020

Sci Rep

119

View full text Add to dashboard Cite

As a cell proliferation biomarker, Ki-67 is principally used in ER+/HER2− breast cancer. However, the importance and the best cutoff point of Ki-67 in triple-negative breast cancer (TNBC) remains unclear and was evaluated in this study.A total of 1800 patients with early invasive TNBC between 2011 and 2016 at Fudan University Shanghai Cancer Center were consecutively recruited for this study. The optimal cutoff for Ki-67 was assessed by Cutoff Finder. Propensity score matching (PSM, ratio = 1:2) was performed to match the Ki-67 low group with the Ki-67 high group. Overall survival (OS) and diseasefree survival (DFS) were compared between the two groups using the Kaplan-Meier method and Cox regression model. The most relevant cutoff value for Ki-67 for prognosis was 30% (p = 0.008). At the cutoff point of 30%, worse DFS and OS were observed in the Ki-67 high group. In multivariate analyses, N-stage (p < 0.001), T-stage (p = 0.038), and Ki-67 at the 30% threshold (p = 0.020) were independently linked to OS. In subgroup analysis, Ki-67 cutoff at 30% had prognostic and predictive potential for DFS with either tumor size ≤2 cm (p = 0.008) or lymph node-negative (N−) (p = 0.038) and especially with t 1 n 0 M 0 (stage I) TNBCs. For 945 N− TNBC patients, adjuvant chemotherapy (CT) was associated with better OS in the Ki-67 high group (p = 0.017) than in the Ki-67 low group (p = 0.875). For stage I/Ki-67 low patients, adjuvant CT did not affect DFS (p = 0.248). Thus, Ki-67 cutoff at 30% had early independent prognostic and predictive potential for OS and DFS in TNBCs, and Ki-67 > 30% was significantly associated with worse prognosis, especially for stage I patients. For stage I/Ki-67 low TNBC patients, the advantage of CT is unclear, providing the basis for future de-escalation therapy.

show abstract

Section: Discussionmentioning

confidence: 92%

The prognostic and predictive potential of Ki-67 in triple-negative breast cancer

Zhu

Chen

Huang

et al. 2020

Sci Rep

119

View full text Add to dashboard Cite

show abstract

“…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]. Taken together, the limited sample size of T1bN0M0 TNBC and the different endpoints used in previous studies have made it difficult to identify the exact effects of chemotherapy in patients with T1bN0M0 TNBC.…”

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%

“…Currently, the National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of chemotherapy in patients with T1bN0M0 TNBC. However, these specific patients have a less than 10% risk of recurrence and may not benefit from adjuvant chemotherapy in some literature [7][8][9]. Therefore, the benefit of adjuvant chemotherapy in patients with T1bN0M0 TNBC remains controversial.…”

Section: Ivyspringmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

“…Considering these factors, the treatment regimens containing ACT should be prescribed in accordance with the risk associated with the different subtypes and their respective biological characteristics. With regard to TNBC tumors of small size, some studies have indicated that a fraction of patients might benefit from adjuvant chemotherapy (11,16). Zaida Morante et al evaluated a T1N0-TNBC-patient cohort diagnosed between 2000 and 2014 at a single institution and found a better outcome in patients treated with ACT (21).…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Wang

et al. 2020

Front. Oncol.

View full text Add to dashboard Cite

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.

show abstract

Effects of adjuvant chemotherapy in T1N0M0 triple-negative breast cancer

Cited by 27 publications

References 35 publications

The prognostic and predictive potential of Ki-67 in triple-negative breast cancer

The prognostic and predictive potential of Ki-67 in triple-negative breast cancer

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

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

Contact Info

Product

Resources

About