Department of Medical Oncology, Catalan Institute of Oncology/Josep Trueta Hospital, Girona, Spain.
Department of Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, NY, USA.
Breast Cancer Res Treat. 2024 Jan;203(2):257-269. doi: 10.1007/s10549-023-07132-6. Epub 2023 Oct 13.
Current guidelines recommendations regarding chemotherapy in small (T1b and T1c), node-negative triple-negative breast cancer (TNBC) differ due to lack of high-quality data. Our study aimed to assess the benefit of adjuvant chemotherapy in patients with T1bN0M0 and T1cN0M0 TNBC.
We obtained data from the Surveillance, Epidemiology, and End Results database for patients with node-negative, T1b/T1c TNBC diagnosed between 2010 and 2020. Logistic regresion models assessed variables associated with chemotherapy administration. We evaluated the effect of chemotherapy on overall survival (OS) and breast cancer specific survival (BCSS) with Kaplan-Meier methods and Cox proportional hazards methods.
We included 11,510 patients: 3,388 with T1b and 8,122 with T1c TNBC. During a median follow-up of 66 months, 305 patients with T1b and 995 with T1c died. After adjusting for clinicopathological, demographic and treatment factors, adjuvant chemotherapy improved OS in T1b TNBC (HR, 0.52; 95% CI, 0.41-0.68 p < 0.001) but did not improve BCSS (HR, 0.70; 95% CI, 0.45-1.07; p = 0.10); the association between chemotherapy and BCSS was not statistically significant in any subgroup. In T1c TNBC, adjuvant chemotherapy improved OS (HR, 0.54; 95% CI, 0.47-0.62; p < 0.001) and BCSS (HR, 0.79; 95% CI, 0.63-0.99; p = 0.043); the benefit of chemotherapy in OS varied by age (P=0.024); moreover, the benefit in BCSS was similar in all subgroups.
Our study results support the use of adjuvant chemotherapy in patients with node-negative, T1c TNBC. Patients with node-negative, T1b TNBC had excellent long-term outcomes; furthermore, chemotherapy was not associated with improved BCSS in these patients.
由于缺乏高质量的数据，目前关于小（T1b 和 T1c）、淋巴结阴性三阴性乳腺癌（TNBC）的化疗指南建议有所不同。我们的研究旨在评估辅助化疗对 T1bN0M0 和 T1cN0M0 TNBC 患者的获益。
我们从监测、流行病学和最终结果数据库中获取了 2010 年至 2020 年间诊断为淋巴结阴性、T1b/T1c TNBC 的患者数据。逻辑回归模型评估了与化疗管理相关的变量。我们使用 Kaplan-Meier 方法和 Cox 比例风险方法评估了化疗对总生存（OS）和乳腺癌特异性生存（BCSS）的影响。
我们纳入了 11510 例患者：3388 例 T1b 和 8122 例 T1c TNBC。中位随访 66 个月期间，305 例 T1b 和 995 例 T1c 患者死亡。在校正了临床病理、人口统计学和治疗因素后，辅助化疗改善了 T1b TNBC 的 OS（HR，0.52；95%CI，0.41-0.68；p<0.001），但未改善 BCSS（HR，0.70；95%CI，0.45-1.07；p=0.10）；化疗与 BCSS 之间的关联在任何亚组中均无统计学意义。在 T1c TNBC 中，辅助化疗改善了 OS（HR，0.54；95%CI，0.47-0.62；p<0.001）和 BCSS（HR，0.79；95%CI，0.63-0.99；p=0.043）；化疗在 OS 中的获益因年龄而异（P=0.024）；此外，BCSS 获益在所有亚组中相似。
我们的研究结果支持对淋巴结阴性、T1c TNBC 患者使用辅助化疗。淋巴结阴性、T1b TNBC 患者有极好的长期预后；此外，这些患者化疗与改善 BCSS 无关。
