Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Department of Radiation Oncology, Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.
Breast. 2018 Oct;41:67-73. doi: 10.1016/j.breast.2018.06.014. Epub 2018 Jul 2.
Multiple ongoing randomized studies are assessing the impact of omission of chemotherapy (CT) in low-risk node-positive Luminal A breast. The goal of this investigation was to evaluate trends and practice patterns of adjuvant CT use in Luminal A pT1-3N1 breast cancer, along with determining the clinical benefit from adjuvant CT in this patient population.
The National Cancer Data Base was queried (2004-2014) for women with pT1-3N1 luminal A invasive ductal carcinoma receiving adjuvant hormonal therapy (HT). Multivariable logistic regression ascertained factors associated with adjuvant CT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with CT/HT vs. HT alone, while sub-stratifying patients by age.
Of 8548 total patients, 5182 (61%) received CT/HT, while 3366 (39%) received HT alone. A steady rise in omission of adjuvant CT was observed, from 14% (2004-2005) to 41% (2012-2014). A decision not to use CT was more likely in more recent time periods, in older patients, at academic centers, following lumpectomy, and with lower T classification (p < 0.05 for all). CT was associated with higher OS in all patients (p < 0.001) and women ≤50 years old (p = 0.030), but not for ages 51-60 (p = 0.116), 61-70 (p = 0.222), or >70 (p = 0.239).
Using CT for Luminal A N1 breast cancer is decreasing over time, primarily in older patients and at academic centers. Although CT is still associated with an OS advantage in all patients, subgroup analysis demonstrated no OS benefit in women >50 years of age. These results have implications on the ongoing randomized trials.
多项正在进行的随机研究评估了在低危淋巴结阳性 Luminal A 乳腺癌中省略化疗（CT）的影响。本研究的目的是评估辅助 CT 在 Luminal A pT1-3N1 乳腺癌中的应用趋势和实践模式，并确定该患者人群中辅助 CT 的临床获益。
从国家癌症数据库（2004-2014 年）中查询接受辅助激素治疗（HT）的 pT1-3N1Luminal A 浸润性导管癌的女性。多变量逻辑回归确定与辅助 CT 给药相关的因素。Kaplan-Meier 分析评估接受 CT/HT 治疗与单独接受 HT 治疗的患者之间的总生存期（OS），同时按年龄对患者进行亚组分层。
在 8548 例患者中，5182 例（61%）接受 CT/HT，3366 例（39%）单独接受 HT。观察到辅助 CT 省略的比例稳步上升，从 2004-2005 年的 14%上升到 2012-2014 年的 41%。在较新的时期、老年患者、学术中心、保乳手术后以及 T 分类较低时，更有可能决定不使用 CT（所有 p 值均＜0.05）。在所有患者（p＜0.001）和≤50 岁的女性（p=0.030）中，CT 与更高的 OS 相关，但在 51-60 岁（p=0.116）、61-70 岁（p=0.222）或＞70 岁（p=0.239）的女性中则无 OS 获益。
随着时间的推移，Luminal A N1 乳腺癌中 CT 的应用正在减少，主要是在老年患者和学术中心。尽管 CT 仍然与所有患者的 OS 优势相关，但亚组分析表明，＞50 岁的女性没有 OS 获益。这些结果对正在进行的随机试验有影响。
