Recurrence risk in small, node-negative, early breast cancer: a multicenter retrospective analysis

Abstract

PurposeRecurrences and deaths are known to occur, even if less frequently, in small, node-negative breast cancer patients, and decision on adjuvant treatments remains controversial. In the present analysis, we evaluate recurrence risk in patients with pT1 a, b, c, node-negative, breast cancer, accordingly with some prognostic biological factors.MethodsWe retrospectively evaluated 900 node-negative patients (pT1a, b, c) surgery treated between 2000 and 2009 in four Italian oncologic centers. We defined 3 different cohorts: ER positive (ER+); Her-2 positive (Her-2+); and triple negative (TN).ResultspT1a was seen in 7.6% of patients, 37.7 % pT1b, 54.8 % pT1c. Concerning the 3 different cohorts, 58.2 % were ER+; 10.8 % were Her-2+; 8.2 % were TN. Overall, chemotherapy was given to 3.0 %, 27.2 %, 69.8 % of pT1a, b, c, respectively, and to 22.7 %, 58.8 %, 68.9 % of ER+, Her-2+, TN subgroups. At a median follow-up of 67 months, 5-year DFS was 96.3 %, 89.2 %, 89.4 % in pT1a, b, c, respectively (100 %, 93.6 %, 89.8 % in ER+; 100 %, 78.7 %, 85.0 % in Her-2+; 100 %, 76.8 %, 85.2 % in TN) (p = ns). At multivariate analysis, histologic grade and Ki-67 resulted independent prognostic factors. Overall, 5-year OS was 98 %, without differences among pT1a, b, c, or among the 3 cohorts.ConclusionsOverall, 5-year DFS was very favorable in this series of small, node-negative breast cancers, but Her-2+ and TN cohorts have a higher recurrence rate than ER+ cohort (p < 0.0001); pT1c, but also pT1b, in Her-2+ and TN subgroups, have a worse outcome, and effective chemotherapy treatment should be considered in these unfavorable subgroups.

Chemotherapy Use and Surgical Treatment by Receptor Subtype in Node-Negative T1a and T1b Female Breast Cancers, Iowa SEER Registry, 2010- to 2012

“…The percent of HER2-positive and TNBC tumors seen are consistent with other series. 18,26,27 The majority of these small HER2-positive tumors in Iowa were also HR-positive. This is consistent with other series looking at T1a,bN0M0 tumors.…”

Important Factors Affecting Adjuvant Treatment Decision in Stage IA Breast Cancer Patients in Turkey

“…Tumors of ≤ 5 mm without ALN metastasis that are ER/PR-positive and HER2-negative do not require chemotherapy, but there is no consensus for tumors of > 5 mm with the same characteristics. Adjuvant chemotherapy has been recommended for HR-negative tumors [9] and HER2-positive tumors of > 1 cm [4]. In the present study, we evaluated the parameters related to treatment decisions in small lymph node-negative breast cancer in our population.…”

“…Tumor size, hormone receptor status, human epidermal growth factor receptor 2 (HER2) overexpression, histological grade, and axillary lymph node (ALN) involvement have been established to be important prognostic factors for recurrence [2,3]. Despite the availability of new prognostic or predictive factors and gene expression profiling, clinicopathological factors are still considered important for therapy decisions [4]. Chemotherapy has marginal benefit for lymph node-negative early breast cancer, because of the relatively low risk of recurrence [5].…”

Triple Negative Breast Cancer: A Review of Clinicopathologic Characteristics And Treatment Options

“…TNBC is usually diagnosed at a younger age [5,26,38], and presents at a higher stage and larger size when compared to the other breast cancer molecular subtypes. Most studies show that TNBC patients have poor prognosis, worse overall survival and earlier recurrence compared with their hormone receptor positive counterparts, even when the diagnosis was made at an early stage [39,40]. Additionally, TNBC has more than 20% greater incidence of visceral metastasis compared to the other breast cancer subtypes, which commonly metastasize to bone [37,41].…”

“…Due to the aggressive nature of TNBC, with high and early incidence of recurrence, many experts advocate the administration of chemotherapy even in the event of node negative small tumors [40]. Patients with TNBC consistently demonstrate poor prognosis when compared with other molecular subtypes of breast cancer, regardless of treatment, and despite early stage disease [39,43].…”