Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China.
Department of General Surgery, Changxing Hospital of Traditional Chinese Medicine, Huzhou, 313100, Zhejiang, China.
BMC Cancer. 2022 Aug 8;22(1):863. doi: 10.1186/s12885-022-09952-z.
There is no clear consensus on the benefits of adjuvant chemotherapy for tumor-node-metastasis (TNM) stage T1 (T1N0M0) breast cancer (BC). Our study investigated the effects of adjuvant chemotherapy on T1N0M0 BC patients.
Seventy-five thousand one hundred thirty-nine patients diagnosed with T1N0M0 BC were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox analyses were performed to investigate the effects of adjuvant chemotherapy on T1a, T1b, and T1cN0M0 BC, including various tumor grades, and four molecular subtypes. Propensity score matching (PSM) was used to eliminate confounding factors and further compare the results between adjuvant chemotherapy and no adjuvant chemotherapy. Additionally, 545 T1N0M0 BC patients treated at the Northern Jiangsu People's Hospital were included as an independent external validation cohort. Univariate and multivariate Cox analyses were used to confirm the effects of adjuvant chemotherapy in T1a, T1b, and T1cN0M0 BC. Survival curves for the different tumor grades and molecular subtypes were plotted using the Kaplan-Meier method.
Adjuvant chemotherapy demonstrated a statistically significant improvement in overall survival (OS) in T1b and T1c BC, but not in T1a BC. Within T1b BC, adjuvant chemotherapy was found to have effects on grade III, and hormone receptor + (HoR +)/human epidermal growth factor receptor 2 + (HER2 +), HoR-/HER2 + , and HoR-/HER2- molecular subtypes, respectively. Adjuvant chemotherapy was beneficial to OS for grade II/III and T1c BC. Identical results were obtained after PSM. We also obtained similar results with external validation cohort, except that adjuvant chemotherapy made a difference in grade II and T1b BC of the external validation dataset.
Partial T1N0M0 BC patients with grade III T1bN0M0, patients with tumor grade II and III T1cN0M0, and excluding those with HoR + /HER2- subtype tumors, could obtain OS benefits from adjuvant chemotherapy.
对于肿瘤-淋巴结-转移（TNM）分期 T1（T1N0M0）期乳腺癌（BC），辅助化疗的获益尚无明确共识。我们的研究旨在探讨辅助化疗对 T1N0M0BC 患者的影响。
从监测、流行病学和最终结果（SEER）数据库中选择了 75139 例诊断为 T1N0M0BC 的患者。采用多变量 Cox 分析探讨辅助化疗对 T1a、T1b 和 T1cN0M0BC 的影响，包括不同的肿瘤分级和四种分子亚型。采用倾向评分匹配（PSM）消除混杂因素，并进一步比较辅助化疗与无辅助化疗的结果。此外，纳入江苏省苏北人民医院 545 例 T1N0M0BC 患者作为独立外部验证队列。采用单变量和多变量 Cox 分析证实辅助化疗在 T1a、T1b 和 T1cN0M0BC 中的作用。采用 Kaplan-Meier 法绘制不同肿瘤分级和分子亚型的生存曲线。
辅助化疗在 T1b 和 T1cBC 中总体生存（OS）有显著改善，但在 T1aBC 中无显著改善。在 T1bBC 中，辅助化疗对 III 级、激素受体阳性（HoR+）/人表皮生长因子受体 2 阳性（HER2+）、HoR-/HER2+和 HoR-/HER2-分子亚型有作用。辅助化疗对 II/III 级和 T1cBC 的 OS 有益。PSM 后得到相同结果。在外部验证队列中也得到了相似的结果，但辅助化疗对外部验证数据集的 II 级和 T1bBC 有差异。
部分 T1N0M0BC 患者，包括 III 级 T1bN0M0、肿瘤分级 II 级和 III 级 T1cN0M0，以及 HoR+ / HER2-亚型肿瘤患者，可从辅助化疗中获得 OS 获益。
