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Management of small T1a/b breast cancer by tumor subtype

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Abstract

Background

The treatment of patients with small (T1a/b) breast cancer is based on retrospective analysis. The influence of intrinsic tumor subtypes on patients’ outcome and treatment decision remains unclear.

Patients and methods

This is a prospective cohort register study including 1008 patients with small T1a/b breast cancer treated between 2003 and 2011. Tumors were grouped by biological characteristics into four different subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative breast cancer (TNBC).

Results

The median follow-up time was 6.5 years. From 919 eligible patients, 408 (44.4%) were classified as luminal A, 246 (26.8%) as luminal B, 183 (19.9%) as HER2 enriched, and 82 (8.9%) as TNBC. A total of 305 (34.2%) patients were treated with systemic therapy. Patients receiving systemic therapy were significantly younger and had lymph node metastasis, higher tumor grade, negative HR, and positive HER2 status. Patients with luminal A tumors demonstrated the best survival rate which improved with systemic therapy. The survival rate of patients with luminal B cancer, HER2-enriched tumors, and TNBC improved by addition of systemic treatment. The effect of systemic treatment was significant in luminal B (p = 0.040) and HER2 overexpressing tumors (p = 0.016). The treatment effect of systemic therapy in HER2-enriched tumors remained significant even after adjustment of other prognostic factors (HR 0.43, CI 0.19–0.98; p = 0.047). Notably, tumor size was not associated with patients’ survival and treatment decision.

Conclusion

The treatment decision of small breast cancer should be made by biological subtype and not by tumor size or lymph node status.

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References

  1. Campiglio M, Sandri M, Sasso M, Bianchi F, Balsari A, Menard S, Tagliabue E (2014) Prognostic role of tumor size in T1 HER2-positive breast cancers treated with adjuvant trastuzumab. Ann Oncol 25:1073–1074. doi:10.1093/annonc/mdu058

    Article  CAS  PubMed  Google Scholar 

  2. Eroles P, Bosch A, Perez-Fidalgo JA, Lluch A (2012) Molecular biology in breast cancer: intrinsic subtypes and signaling pathways. Cancer Treat Rev 38:698–707. doi:10.1016/j.ctrv.2011.11.005

    Article  CAS  PubMed  Google Scholar 

  3. Fan C, Oh DS, Wessels L, Weigelt B, Nuyten DS, Nobel AB, van’t Veer LJ, Perou CM (2006) Concordance among gene-expression-based predictors for breast cancer. N Engl J Med 355:560–569. doi:10.1056/NEJMoa052933

    Article  CAS  PubMed  Google Scholar 

  4. Fisher B, Dignam J, Tan-Chiu E, Anderson S, Fisher ER, Wittliff JL, Wolmark N (2001) Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. J Natl Cancer Inst 93:112–120

    Article  CAS  PubMed  Google Scholar 

  5. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ, Panel M (2011) Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747. doi:10.1093/annonc/mdr304

  6. Gonzalez-Angulo AM, Litton JK, Broglio KR, Meric-Bernstam F, Rakkhit R, Cardoso F, Peintinger F, Hanrahan EO, Sahin A, Guray M, Larsimont D, Feoli F, Stranzl H, Buchholz TA, Valero V, Theriault R, Piccart-Gebhart M, Ravdin PM, Berry DA, Hortobagyi GN (2009) High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol 27:5700–5706. doi:10.1200/JCO.2009.23.2025

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gori S, Clavarezza M, Siena S, Foglietta J, Tarenzi E, Giordano M, Molino A, Graiff C, Fusco V, Alabiso O, Baldini E, Gamucci T, Altavilla G, Dondi D, Venturini M (2012) Adjuvant chemotherapy of pT1a and pT1b breast carcinoma: results from the NEMESI study. BMC Cancer 12:158. doi:10.1186/1471-2407-12-158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hanrahan EO, Valero V, Gonzalez-Angulo AM, Hortobagyi GN (2006) Prognosis and management of patients with node-negative invasive breast carcinoma that is 1 cm or smaller in size (stage 1; T1a, bN0M0): a review of the literature. J Clin Oncol 24:2113–2122. doi:10.1200/JCO.2005.02.8035

    Article  PubMed  Google Scholar 

  9. Henry NL, Somerfield MR, Abramson VG, Allison KH, Anders CK, Chingos DT, Hurria A, Openshaw TH, Krop IE (2016) Role of patient and disease factors in adjuvant systemic therapy decision making for early-stage, operable breast cancer: american society of clinical oncology endorsement of cancer care ontario guideline recommendations. J Clin Oncol 34:2303–2311. doi:10.1200/JCO.2015.65.8609

    Article  PubMed  Google Scholar 

  10. Ignatov T, Eggemann H, Burger E, Costa SD, Ignatov A (2016) Hormone receptor status does not alter the effect of trastuzumab in breast cancer. Endocr Relat Cancer 23:349–355. doi:10.1530/ERC-16-0084

    Article  PubMed  Google Scholar 

  11. Ignatov T, Eggemann H, Burger E, Fettke F, Costa SD, Ignatov A (2015) Moderate level of HER2 expression and its prognostic significance in breast cancer with intermediate grade. Breast Cancer Res Treat 151:357–364. doi:10.1007/s10549-015-3407-2

    Article  CAS  PubMed  Google Scholar 

  12. Perou CM, Sorlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, Fluge O, Pergamenschikov A, Williams C, Zhu SX, Lonning PE, Borresen-Dale AL, Brown PO, Botstein D (2000) Molecular portraits of human breast tumours. Nature 406:747–752. doi:10.1038/35021093

    Article  CAS  PubMed  Google Scholar 

  13. Rodrigues MJ, Peron J, Frenel JS, Vano YA, Wassermann J, Debled M, Picaud F, Albiges L, Vincent-Salomon A, Cottu PH (2013) Benefit of adjuvant trastuzumab-based chemotherapy in T1ab node-negative HER2-overexpressing breast carcinomas: a multicenter retrospective series. Ann Oncol 24:916–924. doi:10.1093/annonc/mds536

    Article  CAS  PubMed  Google Scholar 

  14. Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, Mackey J, Glaspy J, Chan A, Pawlicki M, Pinter T, Valero V, Liu MC, Sauter G, von Minckwitz G, Visco F, Bee V, Buyse M, Bendahmane B, Tabah-Fisch I, Lindsay MA, Riva A, Crown J, Breast Cancer International Research G (2011) Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 365:1273–1283. doi:10.1056/NEJMoa0910383

  15. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Lonning PE, Borresen-Dale AL (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874. doi:10.1073/pnas.191367098

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sotiriou C, Neo SY, McShane LM, Korn EL, Long PM, Jazaeri A, Martiat P, Fox SB, Harris AL, Liu ET (2003) Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA 100:10393–10398. doi:10.1073/pnas.1732912100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. van Ramshorst MS, van der Heiden-van der Loo M, Dackus GM, Linn SC, Sonke GS (2016) The effect of trastuzumab-based chemotherapy in small node-negative HER2-positive breast cancer. Breast Cancer Res Treat 158:361–371. doi:10.1007/s10549-016-3878-9

    Article  PubMed  Google Scholar 

  18. Vaz-Luis I, Ottesen RA, Hughes ME, Mamet R, Burstein HJ, Edge SB, Gonzalez-Angulo AM, Moy B, Rugo HS, Theriault RL, Weeks JC, Winer EP, Lin NU (2014) Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study. J Clin Oncol 32:2142–2150. doi:10.1200/JCO.2013.53.1608

    Article  PubMed  PubMed Central  Google Scholar 

  19. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. doi:10.1016/S0140-6736(07)61602-X

    Article  Google Scholar 

  20. Zhou Q, Yin W, Du Y, Lu J (2014) For or against adjuvant trastuzumab for pT1a-bN0M0 breast cancer patients with HER2-positive tumors: a meta-analysis of published literatures. PLoS ONE 9:e83646. doi:10.1371/journal.pone.0083646

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany

    Tanja Ignatov, Holm Eggemann, Serban Dan Costa & Atanas Ignatov

  2. Institute of Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany

    Elke Burger

Authors
  1. Tanja Ignatov
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  2. Holm Eggemann
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  3. Elke Burger
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  4. Serban Dan Costa
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  5. Atanas Ignatov
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Correspondence to Atanas Ignatov.

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Conflict of interest

The authors have no conflicts of interest.

Ethical standards

The experiments comply with the current laws of Germany and were performed according to the good clinical practice (GCP) guidelines.

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Ignatov, T., Eggemann, H., Burger, E. et al. Management of small T1a/b breast cancer by tumor subtype. Breast Cancer Res Treat 163, 111–118 (2017). https://doi.org/10.1007/s10549-017-4168-x

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