Houvenaeghel G, Goncalves A, Classe J M, Garbay J R, Giard S, Charytensky H, Cohen M, Belichard C, Faure C, Uzan S, Hudry D, Azuar P, Villet R, Gimbergues P, Tunon de Lara C, Martino M, Lambaudie E, Coutant C, Dravet F, Chauvet M P, Chéreau Ewald E, Penault-Llorca F, Esterni B
Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM.
Department of Oncology, Institut Paoli Calmettes, Aix Marseille Université, Marseille.
Ann Oncol. 2014 Mar;25(3):623-628. doi: 10.1093/annonc/mdt532. Epub 2014 Jan 7.
A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST).
Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized.
Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11-15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors.
Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.
T1N0M0 乳腺癌（BC）的一个亚组具有较高的复发可能性，因此可能需要辅助全身治疗（AST）。
对1999年1月至2009年12月期间在法国13个地点接受手术的所有T1期乳腺癌患者进行回顾性分析。AST未标准化。
在8100名接受手术的女性中，5423例患有T1期肿瘤（708例T1a、2208例T1b和2508例T1c，11 - 15毫米）。T1a肿瘤在几个参数方面与T1b肿瘤有显著差异（年龄较小、激素状态阴性和HER2状态阳性更为常见、淋巴管侵犯较少见），呈现出预后良好和不良因素的混合。T1a、b或c肿瘤的总生存率无差异，但T1b肿瘤的无复发生存率显著高于T1a肿瘤（P = 0.001）。多因素分析显示，肿瘤分级、激素治疗和淋巴管侵犯是独立的预后因素。
T1a肿瘤患者相对较差的预后可能是由于该亚组中危险因素的高频率出现（激素受体阴性和HER2过表达频繁）以及AST（内分泌治疗和化疗）的给药频率较低。肿瘤大小可能不是T1期乳腺癌预后的主要决定因素。
