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

Lan, Tian; Lu, Yunyan; Luo, Hua; Yang, Ouou; He, Jinlan; Xu, Huiling; Hu, Zujian

doi:10.7150/jca.52540

Cited by 7 publications

(6 citation statements)

References 28 publications

(33 reference statements)

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“…Although current NCCN guideline recommend chemotherapy for patients with tumors larger than 5mm (10), to our knowledge, the clinical evidence supporting this recommend remains limited. Some studies have reported better prognosis for pT1-2N0M0 TNBC patients who received adjuvant chemotherapy, while other studies failed to prove the survival benefit of adjuvant chemotherapy (8,23,24). In terms of adjuvant radiotherapy, a prospective randomized controlled multi-center study demonstrated that compared to chemotherapy alone, the combination of standard adjuvant chemotherapy and radiotherapy was associated with significant improvements in overall survival and recurrence-free survival in patients with early-stage TNBC after surgery (25).…”

Section: Discussionmentioning

confidence: 99%

Nomogram for Predicting Overall Survival and Assessing the Survival Benefit of Adjuvant Treatment in pT1-2N0M0 Triple-Negative Breast Cancer: A Surveillance, Epidemiology, and End Results-Based Study

Mao

Liu

et al. 2022

Front. Oncol.

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BackgroundAccurate survival prediction of triple-negative breast cancer (TNBC) is essential in the decision-making of adjuvant treatment. The aim of this prospective study was to develop a nomogram that predicts overall survival and assists adjuvant treatment formulation.MethodsA total of 16,977 patients with pT1-2N0M0 TNBC between 2010 and 2015 from the SEER database were enrolled. Independent prognostic factors associated with overall survival (OS) were identified using univariate and multivariate Cox regression hazards method and utilized to compose the nomogram. The survival benefit of adjuvant treatment on OS were analyzed after stratification by nomogram sum-score.ResultsPatients were randomized 7:3 into the training and validation cohorts. Multivariate analysis revealed that age at diagnosis, grade, tumor size, laterality, and mastectomy type were independent prognostic factors of OS and were integrated to develop a nomogram for predicting prognosis. Patients were stratified into 3 prognostic subgroups according to the sum-score of our nomogram. There were no significant differences found in OS between surgery alone and other adjuvant treatment strategies in low risk group. In moderate risk group, patients receiving chemotherapy or the combination of chemotherapy and radiotherapy showed better OS than those receiving surgery alone or radiotherapy alone. For patients in high risk group, the combination of chemotherapy and radiotherapy could maximally improve the overall survival rate of patients.ConclusionA novel nomogram for OS prediction and risk stratification in patients with pT1-2N0M0 TNBC was developed. This cohort study reveals the prognostic roles of different adjuvant treatment strategies in subgroups, which may provide a reference for the decision-making of postoperative treatment, eventually improving prognosis for individual patients.

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Section: Discussionmentioning

confidence: 99%

Nomogram for Predicting Overall Survival and Assessing the Survival Benefit of Adjuvant Treatment in pT1-2N0M0 Triple-Negative Breast Cancer: A Surveillance, Epidemiology, and End Results-Based Study

Mao

Liu

et al. 2022

Front. Oncol.

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“…A recent SEER based study that included 1849 patients demonstrated that T1bN0 TNBC patients had no improvement in BCSS from adjuvant chemotherapy. BCSS was similar in those who received chemotherapy and those who did not receive chemotherapy [36]. De-escalation of adjuvant chemotherapy could be considered for pT1b TNBC patients based on the above retrospective real-world data.…”

Section: De-escalation Of Systemic Therapy In Low Clinical Risk Groupmentioning

confidence: 92%

Systemic Therapy De-Escalation in Early-Stage Triple-Negative Breast Cancer: Dawn of a New Era?

Gupta

Roy

Gupta

et al. 2022

Cancers

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Early-stage triple negative breast cancer (TNBC) has been traditionally treated with surgery, radiation, and chemotherapy. The current standard of care systemic treatment of early-stage II and III TNBC involves the use of anthracycline-cyclophosphamide and carboplatin-paclitaxel with pembrolizumab in the neoadjuvant setting followed by adjuvant pembrolizumab per KEYNOTE-522. It is increasingly clear that not all patients with early-stage TNBC need this intensive treatment, thus paving the way for exploring opportunities for regimen de-escalation in selected subgroups. For T1a tumors (≤5 mm), chemotherapy is not used, and for tumors 6–10 mm (T1b) in size with negative lymph nodes, retrospective studies have failed to show a significant benefit with chemotherapy. In low-risk patients, anthracycline-free chemotherapy may be as effective as conventional therapy, as shown in some studies where replacing anthracyclines with carboplatin has shown non-inferior results for pathological complete response (pCR), which may form the backbone of future combination therapies. Recent advances in our understanding of TNBC heterogeneity, mutations, and surrogate markers of response such as pCR have enabled the development of multiple treatment options in the (neo)adjuvant setting in order to de-escalate treatment. These de-escalation studies based on tumor mutational status, such as using Poly ADP-ribose polymerase inhibitors (PARPi) in patients with BRCA mutations, and new immunotherapies such as PD1 blockade, have shown a promising impact on pCR. In addition, the investigational use of (bio)markers, such as high levels of tumor-infiltrating lymphocytes (TILs), low levels of tumor-associated macrophages (TAMs), and complete remission on imaging, also look promising. In this review, we cover the current standard of care systemic treatment of early TNBC and review the opportunities for treatment de-escalation based on clinical risk factors, biomarkers, mutational status, and molecular subtype.

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“…In another study, the bene t of adjuvant chemotherapy was not observed in pT1b patients, with 5-year RFS of 91.4% and 90%, respectively (HR = 0.64, 95% CI, 0.05-7.74, p = 0.724) [9]. A recent retrospective study of 1849 patients based on the SEER database showed that BCSS was similar in T1bN0 TNBC patients receiving chemotherapy and those not receiving chemotherapy (96.1% vs 96.0%, p = 0.820) [23]. A meta-analysis was recently published in which adjuvant chemotherapy reduced the recurrence rate of T1mi/a/bN0 TNBC, especially T1bN0 [24].…”

Section: Whether Chemotherapy Is Bene Cial In Patients With T1bn0 Tnbcmentioning

confidence: 96%

Impact of Adjuvant Chemotherapy on Survival Benefit in T1N0 Triple Negative Breast Cancer Based on SEER Database by Age Group

Wang

Sun

Gao

2023

Preprint

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BACKGROUND We aimed to analyze the survival benefit of adjuvant chemotherapy in patients with T1N0M0 triple-negative breast cancer (TNBC) (age-stratified and tumor size-stratified) to guide more precise treatment. METHODS This study recruited 6482 pT1N0M0 TNBC patients from 2010–2015 in the SEER database (*Stat 8.3.6 software). The χ[2] test was used to compare categorical variables between different tumor sizes. OS and BCSS of patients with T1mic, T1a, T1b and T1cN0M0 TNBC were studied and Kaplan-Meier survival curves were plotted for the prognosis of patients receiving versus not receiving chemotherapy stratified by age and tumor size. RESULTS A total of 6482 T1N0M0 TNBC patients were included in this study, with a total of 4244 (65.47%) patients receiving adjuvant chemotherapy and 2238 (34.53%) not receiving adjuvant chemotherapy, whose 5-year OS was 92.4% and 85.4% (p < 0.001) and 5-year BCSS was 95.1% and 94.9% (p = 0.46), respectively. Among them, 15.2% (16/105), 24.5% (159/650), 58.7% (1046/1781), and 76.6% (3023/3946) received chemotherapy for T1mic, T1a, T1b, and T1c, respectively. The 5-year OS with and without chemotherapy was 93.3% vs. 94.7% (p = 0.95), 98.7% vs. 94.4% (p = 0.004), 94.8% vs. 87.7% (p < 0.001), and 91.2% vs. 77.0% (p < 0.001), respectively, and the 5-year BCSS was 100% vs. 93.3% (p = 0.026),99.3% vs 98.1% (p = 0.22), 96.9% vs 96.3% (p = 0.36), and 94.3% vs 91.4% (p < 0.001), respectively. Among the T1mic patients, receiving chemotherapy did not improve OS (p = 0.95), but instead decreased BCSS (p = 0.026). When patients were stratified by age, it was found that for age > 65 years, T1a patients receiving chemotherapy did not improve OS and BCSS (p = 0.07, p = 0.45). For T1b patients, receiving chemotherapy at age > 75 years did not improve OS and BCSS (p = 0.065, p = 0.13). For T1c patients, receiving chemotherapy did not improve OS and BCSS at age > 80 years (p = 0.19, p = 0.15). CONCLUSION This study found that adjuvant chemotherapy improved OS but not BCSS in T1N0TNBC patients. T1mic patients receiving chemotherapy did not improve OS but decreased BCSS, T1a and T1b patients adjuvant chemotherapy improved OS but not BCSS. >65 years old T1a, > 75 years old T1b and > 80 years old Tc patients receiving chemotherapy did not improve survival and could be used as a clinical reference for patients exempted from chemotherapy.

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

Cited by 7 publications

References 28 publications

Nomogram for Predicting Overall Survival and Assessing the Survival Benefit of Adjuvant Treatment in pT1-2N0M0 Triple-Negative Breast Cancer: A Surveillance, Epidemiology, and End Results-Based Study

Nomogram for Predicting Overall Survival and Assessing the Survival Benefit of Adjuvant Treatment in pT1-2N0M0 Triple-Negative Breast Cancer: A Surveillance, Epidemiology, and End Results-Based Study

Systemic Therapy De-Escalation in Early-Stage Triple-Negative Breast Cancer: Dawn of a New Era?

Impact of Adjuvant Chemotherapy on Survival Benefit in T1N0 Triple Negative Breast Cancer Based on SEER Database by Age Group

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