Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA.
Division of Medical Oncology, University of Colorado Anschutz Medical Campus, 12801 East 17th Ave, Mailstop 8117, Aurora, CO, 80045, USA.
Breast Cancer Res Treat. 2022 Jan;191(2):389-399. doi: 10.1007/s10549-021-06424-z. Epub 2021 Oct 27.
Adjuvant chemotherapy reduces recurrence in early-stage triple-negative breast cancer (TNBC). However, data are lacking evaluating anthracycline + taxane (ATAX) versus taxane-based (TAX) chemotherapy in older women with node-negative TNBC, as they are often excluded from trials. The purpose of this study was to evaluate the effect of adjuvant ATAX versus TAX on cancer-specific (CSS) and overall survival (OS) in older patients with node-negative TNBC.
Using the SEER-Medicare database, we selected patients aged ≥ 66 years diagnosed with Stage T1-4N0M0 TNBC between 2010 and 2015 (N = 3348). Kaplan-Meier survival curves and adjusted Cox proportional hazards models were used to estimate 3-year OS and CSS. Multivariant Cox regression analysis was used to identify independent factors associated with use of ATAX compared to TAX.
Approximately half (N = 1679) of patients identified received chemotherapy and of these, 58.6% (N = 984) received TAX, 25.0% (N = 420) received ATAX, and 16.4% (N = 275) received another regimen. Three-year CSS and OS was improved with any adjuvant chemotherapy from 88.9 to 92.2% (p = 0.0018) for CSS and 77.2% to 88.6% for OS (p < 0.0001). In contrast, treatment with ATAX compared to TAX was associated with inferior 3-year CSS and OS. Three-year CSS was 93.7% with TAX compared to 89.8% (p = 0.048) for ATAX and OS was 91.0% for TAX and 86.4% for ATAX (p = 0.032).
While adjuvant chemotherapy was associated with improved clinical outcomes, the administration of ATAX compared to TAX was associated with inferior 3-year OS and CSS in older women with node-negative TNBC. The use of adjuvant ATAX should be considered carefully in this patient population.
辅助化疗可降低早期三阴性乳腺癌（TNBC）的复发率。然而，缺乏评估在无淋巴结转移的老年 TNBC 女性中蒽环类药物+紫杉烷（ATAX）与紫杉烷类（TAX）化疗的疗效的数据，因为这些患者通常被排除在试验之外。本研究旨在评估辅助 ATAX 与 TAX 对无淋巴结转移的老年 TNBC 患者的癌症特异性（CSS）和总生存（OS）的影响。
使用 SEER-Medicare 数据库，我们选择了 2010 年至 2015 年间诊断为 T1-4N0M0 期 TNBC 的年龄≥66 岁的患者（N=3348）。采用 Kaplan-Meier 生存曲线和调整后的 Cox 比例风险模型估计 3 年 OS 和 CSS。多变量 Cox 回归分析用于确定与接受 ATAX 治疗相比接受 TAX 治疗的独立因素。
约一半（N=1679）的患者接受了化疗，其中 58.6%（N=984）接受了 TAX，25.0%（N=420）接受了 ATAX，16.4%（N=275）接受了其他方案。接受任何辅助化疗均可提高 3 年 CSS 和 OS，从 88.9%提高到 92.2%（p=0.0018），OS 从 77.2%提高到 88.6%（p<0.0001）。相比之下，与 TAX 相比，接受 ATAX 治疗与 3 年 CSS 和 OS 较差相关。TAX 组的 3 年 CSS 为 93.7%，ATAX 组为 89.8%（p=0.048），TAX 组的 OS 为 91.0%，ATAX 组为 86.4%（p=0.032）。
虽然辅助化疗与临床结局改善相关，但在无淋巴结转移的老年 TNBC 女性中，与 TAX 相比，接受 ATAX 治疗与 3 年 OS 和 CSS 较差相关。在该患者人群中，应慎重考虑使用辅助 ATAX。
