Rossi Lea, Stevens Denise, Pierga Jean-Yves, Lerebours Florence, Reyal Fabien, Robain Mathieu, Asselain Bernard, Rouzier Roman
Institut Curie, Paris, France; Equipe d'Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France.
Institut Curie, Paris, France.
PLoS One. 2015 Jul 27;10(7):e0132853. doi: 10.1371/journal.pone.0132853. eCollection 2015.
The impact of adjuvant chemotherapy on breast cancer prognosis has been demonstrated in randomized trials, but its impact is unknown in real-world populations. The aim of this study was to evaluate the effect of adjuvant chemotherapy on the survival of breast cancer patients in an unselected population.
This prospective cohort study included 32,502 women treated at the Institut Curie between 1981 and 2008 for a first invasive breast cancer without metastasis. The patients were matched based on their propensity score to receive adjuvant chemotherapy.
The matching generated a subsample of 9,180 patients with an overlapping propensity score. In the group without chemotherapy, the overall survival (OS) rates at 5 and 10 years of follow-up were 87.6% (95% CI [86.7-88.6]) and 75.0% (95% CI [73.6-76.5]), respectively, versus 92.1% (95% CI [91.3-92.9]) and 81.9% (95% CI [80.6-83.2]), respectively, in the chemotherapy group. Distant disease-free survival (DDFS) was significantly improved in the five first years (absolute benefit of 3.5%). In a multivariate analysis, adjuvant chemotherapy was associated with better OS (HR = 0.75, 95% CI [0.69-0.83], p<0.0001) and DDFS (HR = 0.82, 95% CI [0.75-0.90], p<0.0001).
Adjuvant chemotherapy significantly improves OS and DDFS rates in an unselected population, in accordance with previous results reported by randomized trials.
辅助化疗对乳腺癌预后的影响已在随机试验中得到证实，但其在现实人群中的影响尚不清楚。本研究的目的是评估辅助化疗对未选择人群中乳腺癌患者生存的影响。
这项前瞻性队列研究纳入了1981年至2008年间在居里研究所接受治疗的32502名首次发生浸润性乳腺癌且无转移的女性。根据患者接受辅助化疗的倾向评分进行匹配。
匹配产生了一个倾向评分重叠的9180名患者的子样本。在未接受化疗的组中，随访5年和10年的总生存率（OS）分别为87.6%（95%CI[86.7 - 88.6]）和75.0%（95%CI[73.6 - 76.5]），而化疗组分别为92.1%（95%CI[91.3 - 92.9]）和81.9%（95%CI[80.6 - 83.2]）。远处无病生存率（DDFS）在最初五年有显著改善（绝对获益为3.5%）。在多变量分析中，辅助化疗与更好的OS（HR = 0.75，95%CI[0.69 - 0.83]，p<0.0001）和DDFS（HR = 0.82，95%CI[0.75 - 0.90]，p<0.0001）相关。
辅助化疗显著提高了未选择人群的OS和DDFS率，与随机试验先前报道的结果一致。
