Impact of adjuvant chemotherapy on survival of women with T1N0M0, hormone receptor negative breast cancer |
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| Institution: | 1. Dept of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyoku, Kyoto 606-8501, Japan;2. Dept of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;3. Dept of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;4. Dept of Clinical Oncology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;5. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, Netherlands;1. University College London, UK;2. London School of Hygiene and Tropical Medicine, UK;3. MRC Clinical Trials Unit at UCL, London, UK;1. Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan;2. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th floor, Boston, MA, 02115 USA;3. Department of Urology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan;1. Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;2. School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;3. Centre of Excellence for Public Health (NI), Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;1. Occupational Cancer Research Centre, Cancer Care Ontario, Canada;2. Institute of Medical Science, University of Toronto, Canada;3. Dalla Lana School of Public Health, University of Toronto, Canada;4. Department of Health Sciences, Carleton University, Canada;5. Institut Armand-Frappier, Institut National de la Recherche Scientifique, Canada;6. CHAIM Research Centre, Carleton University, Canada;1. Registre des cancers du Bas-Rhin, Laboratoire d’Épidémiologie et de Santé Publique, EA3430, FMTS, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg CEDEX, France;2. Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, 1 place de l’hôpital, 67091 Strasbourg CEDEX, France;3. Service d’épidémiologie et de biostatistique, Centre Paul Strauss, 3 rue de la porte de l’hôpital, 67065 Strasbourg CEDEX, France;4. Registre des tumeurs de l''Hérault, Centre de Recherche, 208 rue des Apothicaires, 34298 Montpellier CEDEX 5, France;5. Registre des cancers de la Manche, Centre Hospitalier Public du Cotentin, 46 rue du Val de Saire, 50102 Cherbourg-Octeville, France;6. Registre des cancers du Tarn, 1, rue Lavazière BP 37, 81001 Albi CEDEX, France;7. Institut Claudius Regaud, IUCT-O, LEASP – UMR 1027 Inserm – Université Toulouse III, 1 avenue Irène Joliot-Curie, 31059 Toulouse CEDEX 9, France;8. Registre du cancer de la Somme, Service Épidémiologie, Hygiène et Santé Publique, Centre Hospitalier Universitaire Nord, 1 place Victor Pauchet, 80054 Amiens CEDEX 1, France;9. Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo- Universitaire n°0350, Centre Hospitalier Universitaire Nord, avenue de la Côte de Nacre, 14033 Caen CEDEX, France;10. Registre des cancers de Loire-Atlantique et Vendée, Centre Hospitalier Universitaire de Nantes, 50 route de Saint-Sébastien, 44093 Nantes CEDEX 1, France;11. Registre général des cancers de Lille et de sa région, GCS C2RC, Centre Hospitalier Régional Universitaire de Lille Hôpital Calmette, boulevard du Professeur Jules Leclercq, 59037 Lille CEDEX, France;12. Registre des tumeurs du Doubs et du Territoire de Belfort ? EA3181, Centre Hospitalier Régional Universitaire de Besançon Saint-Jacques, 2 place Saint-Jacques, 25030 Besançon CEDEX, France;13. Registre des tumeurs digestives du Calvados, Cancers & Préventions – U 1086 Inserm, Centre François Baclesse, 3 avenue du Général Harris, BP 5026 14076 Caen CEDEX 5, France;14. Registre des cancers de l’Isère, Centre Hospitalier Universitaire de Grenoble Pavillon E, boulevard de la Chantourne BP 217, 38043 Grenoble CEDEX 9, France;15. Registre général des tumeurs du Calvados, Cancers & Préventions – U 1086 Inserm, Centre François Baclesse, 3 avenue du Général Harris, BP 5026 14076 Caen CEDEX 5, France;p. Francim: Réseau français des registres des cancers, 31073 Toulouse, France;1. School of Public Health, Curtin University, Kent Street, Bentley, Western Australia, 6102, Australia;2. Department of Epidemiology and Biostatistics, St Mary’s Campus, Imperial College London, Norfolk Place, London, W2 1 PG, United Kingdom;3. School of Public Health, Edward Ford Building A27, University of Sydney, New South Wales, 2006, Australia;4. Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia;5. School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia |
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| Abstract: | BackgroundThe benefit of adjuvant chemotherapy in women with T1N0M0 breast cancers is unclear. While gene expression-based prognostic assays may aid management of women with early estrogen receptor (ER) positive tumors, therapeutic decision-making in women with early stage ER negative tumors remains fraught with difficulties. We investigated the association between adjuvant chemotherapy and overall survival in women with T1N0M0, hormone receptor negative breast cancers.MethodAll newly diagnosed breast cancer patients with node-negative and hormone receptor negative tumors measuring ≤ 2 cm at the University Malaya Medical Centre (Malaysia) from 1993 to 2013 were included. Mortality of patients with and without adjuvant chemotherapy were compared and adjusted for possible confounders using propensity score.ResultsOf 6732 breast cancer patients, 341 (5.1%) had small (≤2 cm), node-negative and hormone receptor negative tumors at diagnosis. Among them, only 214 (62.8%) received adjuvant chemotherapy. Five-year overall survival was 88.1% (95% confidence interval (CI): 82.0%–94.2%) for patients receiving chemotherapy and 89.6% (95% CI: 85.1%–94.1%) for patients without chemotherapy. Chemotherapy was not associated with survival following adjustment for age, ethnicity, tumor size, tumor grade, HER2 status, lympho-vascular invasion, type of surgery and radiotherapy administration. However, chemotherapy was associated with a significant survival advantage (adjusted hazard ratio: 0.35, 95%CI: 0.14–0.91) in a subgroup of women with high-grade tumors.ConclusionAdjuvant chemotherapy does not appear to be associated with a survival benefit in women with T1N0M0, hormone receptor negative breast cancer except in those with high-grade tumors. |
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| Keywords: | Chemotherapy T1N0M0 breast cancer Hormone receptor negative breast cancer Survival Asia |
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