Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
JAMA Netw Open. 2020 Nov 2;3(11):e2021881. doi: 10.1001/jamanetworkopen.2020.21881.
IMPORTANCE: Adjuvant chemotherapy remains the only recommended treatment for patients with triple-negative breast cancer (TNBC). However, the existing evidence is not enough to recommend adjuvant therapies to patients with T1 N0 M0 TNBC. OBJECTIVE: To evaluate the association of different adjuvant therapies with survival outcome in patients with T1 N0 M0 TNBC stratified by cancer stage and age. DESIGN, SETTING, AND PARTICIPANTS: Postoperative patients diagnosed as having T1 N0 M0 TNBC between 2010 and 2015 who were enrolled in the Surveillance, Epidemiology, and End Results cancer registry program were included in this population-based cohort study. Data analysis was performed from March 27, 2019, to August 10, 2020. EXPOSURES: Chemotherapy and radiotherapy. MAIN OUTCOMES AND MEASURES: Kaplan-Meier curve and univariate and multivariable Cox proportional hazards regression analyses were performed to compare overall survival (OS) and breast cancer-specific survival (BCSS) between the different treatments. RESULTS: A cohort of 7739 eligible patients (mean [SD] age, 59.5 [12.4] years; all female) were included in the present study. The 5-year OS of the total patients was 91.7% (95% CI, 90.9%-92.5%), and median follow-up was 45 months (95% CI, 44-46 months). Patients aged 70 years and older or with T1a TNBC were more likely to receive adjuvant radiotherapy than chemotherapy. Although any adjuvant therapy could improve OS in T1 N0 M0 TNBC, only chemotherapy was associated with significantly better breast cancer-specific survival (BCSS adjusted hazard ratio: 0.657; 95% CI, 0.460-0.939; P = .02). Adjuvant radiotherapy after breast-conserving surgery was associated with better OS and BCSS in patients aged 70 years and older but not in those younger than 70 years. For patients with T1c BC, chemotherapy after breast-conserving surgery or other surgery was associated with improved OS, whereas only chemotherapy after other surgery was associated with better BCSS. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that adjuvant therapies could improve OS in patients with T1 N0 M0 TNBC, whereas only chemotherapy was associated with better BCSS. Older patients with early-stage TNBC may benefit from adjuvant radiotherapy. Administration of adjuvant therapies to patients with different ages and cancer stages should be discussed carefully, which necessitates guidance from updated guidelines.
重要性：辅助化疗仍然是三阴性乳腺癌（TNBC）患者的唯一推荐治疗方法。然而，现有的证据还不足以向 T1N0M0 TNBC 患者推荐辅助治疗。 目的：评估不同辅助治疗方法与 T1N0M0 TNBC 患者生存结局的相关性，这些患者按癌症分期和年龄进行分层。 设计、地点和参与者：本基于人群的队列研究纳入了 2010 年至 2015 年间在监测、流行病学和最终结果癌症登记计划中诊断为 T1N0M0 TNBC 的术后患者。数据分析于 2019 年 3 月 27 日至 2020 年 8 月 10 日进行。 暴露因素：化疗和放疗。 主要结局和测量：采用 Kaplan-Meier 曲线和单变量及多变量 Cox 比例风险回归分析比较不同治疗方法之间的总生存（OS）和乳腺癌特异性生存（BCSS）。 结果：本研究共纳入 7739 例符合条件的患者（平均[标准差]年龄 59.5[12.4]岁；均为女性）。所有患者的 5 年 OS 为 91.7%（95%CI，90.9%-92.5%），中位随访时间为 45 个月（95%CI，44-46 个月）。70 岁及以上或 T1a TNBC 患者更可能接受辅助放疗而非化疗。尽管任何辅助治疗都可以改善 T1N0M0 TNBC 的 OS，但只有化疗与显著改善的乳腺癌特异性生存相关（调整后的危险比：0.657；95%CI，0.460-0.939；P=0.02）。保乳手术后辅助放疗与 70 岁及以上患者的 OS 和 BCSS 改善相关，但与 70 岁以下患者无关。对于 T1cBC 患者，保乳手术后或其他手术后化疗与 OS 改善相关，而仅其他手术后化疗与 BCSS 改善相关。 结论和相关性：本队列研究结果表明，辅助治疗可改善 T1N0M0 TNBC 患者的 OS，而只有化疗与改善 BCSS 相关。早期 TNBC 的老年患者可能从辅助放疗中获益。应根据更新的指南仔细讨论对不同年龄和癌症分期的患者使用辅助治疗的问题，这需要指南提供指导。
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