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Evaluation of a beneficial effect of adjuvant chemotherapy in patients with stage I triple-negative breast cancer: a population-based study using the SEER 18 database

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effect of adjuvant chemotherapy on improving the prognosis of patients with stage I triple-negative breast cancer (TNBC).

Methods

TNBC patients diagnosed in the SEER 18 database from 2010 to 2015 were included. Kaplan–Meier plots and log-rank tests were used to compare the differences in breast cancer-specific survival (BCSS) and overall survival (OS) between subgroups of variables. A Cox proportional hazard model was used to determine the prognostic factors affecting BCSS and OS.

Results

A total of 9256 patients were enrolled in this study. Among these patients, 380 died from breast cancer, and 703 died from all causes. Patients who received chemotherapy had significantly better BCSS and OS than those who did not receive chemotherapy for stage T1cN0M0 (BCSS, hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.51–0.90; OS, HR = 0.54, 95% CI 0.44–0.67) and stage IB (BCSS, HR = 0.39, 95% CI 0.16–0.95; OS, HR = 0.41, 95% CI 0.19–0.87) disease. Patients who received chemotherapy did not have significantly better BCSS or OS than those who did not receive chemotherapy for stage T1aN0M0 or T1bN0M0 disease. The patients who received chemotherapy in the poorly differentiated and undifferentiated groups had better BCSS (HR = 0.68, 95% CI 0.52–0.88) and OS (HR = 0.54, 95% CI 0.44–0.66) than the patients who did not receive chemotherapy.

Conclusion

According to current clinical guidelines, patients with stage T1bN0M0 TNBC are probably overtreated. The prognosis of these patients with stage T1aN0M0 or T1bN0M0 disease is good enough that adjuvant chemotherapy cannot improve it further.

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Data availability

All data generated or analyzed during this study are available from the corresponding author upon reasonable request.

References

  1. Livasy CA, Karaca G, Nanda R, Tretiakova MS, Olopade OI, Moore DT, Perou CM (2006) Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol 19(2):264–271. https://doi.org/10.1038/modpathol.3800528

    Article  CAS  PubMed  Google Scholar 

  2. Foulkes WD, Smith IE, Reis-Filho JS (2010) Triple-negative breast cancer. N Engl J Med 363(20):1938–1948. https://doi.org/10.1056/NEJMra1001389

    Article  CAS  PubMed  Google Scholar 

  3. Anders CK, Carey LA (2009) Biology, metastatic patterns, and treatment of patients with triple-negative breast cancer. Clin Breast Cancer 9(Suppl 2):S73–S81. https://doi.org/10.3816/CBC.2009.s.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong Y-N, Blayney DW, Niland JC, Winer EP, Weeks JC (2012) Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer 118(22):5463–5472. https://doi.org/10.1002/cncr.27581

    Article  PubMed  PubMed Central  Google Scholar 

  5. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ, Martino S, Perez EA, Muss HB, Norton L, Hudis C, Winer EP (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295(14):1658–1667. https://doi.org/10.1001/jama.295.14.1658

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Poggio F, Bruzzone M, Ceppi M, Pondé NF, La Valle G, Del Mastro L, de Azambuja E, Lambertini M (2018) Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer: a systematic review and meta-analysis. Ann Oncol 29(7):1497–1508. https://doi.org/10.1093/annonc/mdy127

    Article  CAS  PubMed  Google Scholar 

  7. Schmidt F, Hartwagner KA, Spork EB, Groell R (1998) Medical audit after 26,711 breast imaging studies: improved rate of detection of small breast carcinomas (classified as Tis or T1a, b). Cancer 83(12):2516–2520. https://doi.org/10.1002/(sici)1097-0142(19981215)83:12<2516:aid-cncr16>3.0.co;2-#

    Article  CAS  PubMed  Google Scholar 

  8. Welch HG, Prorok PC, O'Malley AJ, Kramer BS (2016) Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 375(15):1438–1447. https://doi.org/10.1056/NEJMoa1600249

    Article  PubMed  Google Scholar 

  9. Untch M, Thomssen C, Bauerfeind I, Braun M, Brucker SY, Felberbaum R, Hagemann F, Haidinger R, Hönig A, Huober J, Jackisch C, Kolberg H-C, Kolberg-Liedtke C, Kühn T, Lüftner D, Maass N, Reimer T, Schneeweiss A, Schumacher-Wulf E, Schütz F, Thill M, Wuerstlein R, Fasching PA, Harbeck N (2019) Primary therapy of early breast cancer: evidence, controversies, consensus: Spectrum of Opinion of German Specialists on the 16th St Gallen International Breast Cancer Conference (Vienna 2019). Geburtshilfe Frauenheilkd 79(6):591–604. https://doi.org/10.1055/a-0897-6457

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E (2019) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 30(8):1194–1220. https://doi.org/10.1093/annonc/mdz173

    Article  CAS  PubMed  Google Scholar 

  11. Bertucci F, Finetti P, Cervera N, Esterni B, Hermitte F, Viens P, Birnbaum D (2008) How basal are triple-negative breast cancers? Int J Cancer 123(1):236–240. https://doi.org/10.1002/ijc.23518

    Article  CAS  PubMed  Google Scholar 

  12. Rakha EA, Elsheikh SE, Aleskandarany MA, Habashi HO, Green AR, Powe DG, El-Sayed ME, Benhasouna A, Brunet JS, Akslen LA, Evans AJ, Blamey R, Reis-Filho JS, Foulkes WD, Ellis IO (2009) Triple-negative breast cancer: distinguishing between basal and nonbasal subtypes. Clin Cancer Res 15(7):2302–2310. https://doi.org/10.1158/1078-0432.CCR-08-2132

    Article  CAS  PubMed  Google Scholar 

  13. Engel J, Eckel R, Kerr J, Schmidt M, Fürstenberger G, Richter R, Sauer H, Senn HJ, Hölzel D (2003) The process of metastasisation for breast cancer. Eur J Cancer 39(12):1794–1806. https://doi.org/10.1016/s0959-8049(03)00422-2

    Article  CAS  PubMed  Google Scholar 

  14. Husemann Y, Geigl JB, Schubert F, Musiani P, Meyer M, Burghart E, Forni G, Eils R, Fehm T, Riethmuller G, Klein CA (2008) Systemic spread is an early step in breast cancer. Cancer Cell 13(1):58–68. https://doi.org/10.1016/j.ccr.2007.12.003

    Article  CAS  PubMed  Google Scholar 

  15. Gerratana L, Fanotto V, Bonotto M, Bolzonello S, Minisini AM, Fasola G, Puglisi F (2015) Pattern of metastasis and outcome in patients with breast cancer. Clin Exp Metastasis 32(2):125–133. https://doi.org/10.1007/s10585-015-9697-2

    Article  CAS  PubMed  Google Scholar 

  16. Vona-Davis L, Rose DP, Gadiyaram V, Ducatman B, Hobbs G, Hazard H, Kurian S, Abraham J (2014) Breast cancer pathology, receptor status, and patterns of metastasis in a rural Appalachian population. J Cancer Epidemiol 2014:170634. https://doi.org/10.1155/2014/170634

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pagani O, Price KN, Gelber RD, Castiglione-Gertsch M, Holmberg SB, Lindtner J, Thürlimann B, Collins J, Fey MF, Coates AS, Goldhirsch A (2009) Patterns of recurrence of early breast cancer according to estrogen receptor status: a therapeutic target for a quarter of a century. Breast Cancer Res Treat 117(2):319–324. https://doi.org/10.1007/s10549-008-0282-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Parise CA, Caggiano V (2017) Risk of mortality of node-negative, ER/PR/HER2 breast cancer subtypes in T1, T2, and T3 tumors. Breast Cancer Res Treat 165(3):743–750. https://doi.org/10.1007/s10549-017-4383-5

    Article  PubMed  Google Scholar 

  19. Aalders KC, Postma EL, Strobbe LJ, van der Heiden-van der Loo M, Sonke GS, Boersma LJ, van Diest PJ, Siesling S, van Dalen T (2016) Contemporary locoregional recurrence rates in young patients with early-stage breast cancer. J Clin Oncol 34(18):2107–2114. https://doi.org/10.1200/JCO.2015.64.3536

    Article  PubMed  Google Scholar 

  20. Ren YX, Hao S, Jin X, Ye FG, Gong Y, Jiang YZ, Shao ZM (2019) Effects of adjuvant chemotherapy in T1N0M0 triple-negative breast cancer. Breast 43:97–104. https://doi.org/10.1016/j.breast.2018.11.011

    Article  PubMed  Google Scholar 

  21. Bhoo-Pathy NT, Inaida S, Tanaka S, Taib NA, Yip C-H, Saad M, Kawakami K, Bhoo-Pathy N (2017) Impact of adjuvant chemotherapy on survival of women with T1N0M0, hormone receptor negative breast cancer. Cancer Epidemiol 48:56–61. https://doi.org/10.1016/j.canep.2017.03.007

    Article  PubMed  Google Scholar 

  22. Clarke M, Coates AS, Darby SC, Davies C, Gelber RD, Godwin J, Goldhirsch A, Gray R, Peto R, Pritchard KI, Wood WC (2008) Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet 371(9606):29–40. https://doi.org/10.1016/S0140-6736(08)60069-0

    Article  CAS  PubMed  Google Scholar 

  23. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, Ollila DW, Sartor CI, Graham ML, Perou CM (2007) The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13(8):2329–2334

    Article  CAS  Google Scholar 

  24. 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(20):2142–2150. https://doi.org/10.1200/JCO.2013.53.1608

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was supported by Research Projects of Beijing Hospital (BJ-2015-103).

Author information

Author notes

  1. Zhong-Li Du, Yang Wang, Ding-Yuan Wang, and Li Zhang have contributed equally to this work.

Authors and Affiliations

  1. National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China

    Zhong-Li Du & Cheng-Shan Xu

  2. Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Yang Wang, Ding-Yuan Wang, Ji-Dong Gao & Bai-Lin Zhang

  3. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China

    Li Zhang

  4. Comprehensive Oncology Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Zhi-Min Bian

  5. Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China

    Ying Deng, Dong-Cai Lin & Li Xie

  6. Department of Breast Surgery, Yulin Xingyuan Hospital, Yulin, Shaanxi Province, China

    Yao Jia

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  1. Zhong-Li Du
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Contributions

Z-LD, YW, D-YW and LZ: substantially contributed to the design of the acquisition, analysis and interpretation of the data, and the writing of the manuscript. Z-MB, YD, C-SX, D-CL, LX and YJ: contributed to the formal analysis, including the application of statistics, mathematics, calculations or other forms of technology to analyze or synthesize the research data, as well as the writing of the manuscript. J-DG and B-LZ were responsible for final approval of the version to be submitted and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

Corresponding authors

Correspondence to Ji-Dong Gao or Bai-Lin Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The Data Use Agreement for the SEER 1973–2016 Research Data File was completed. All procedures performed in this study involving human participants were performed in accordance with the ethical standards of the institutional research committees.

Informed consent

Informed consent was obtained from all individual participants included in the SEER research.

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Bai-Lin Zhang and Ji-Dong Gao are corresponding authors.

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Du, ZL., Wang, Y., Wang, DY. et al. Evaluation of a beneficial effect of adjuvant chemotherapy in patients with stage I triple-negative breast cancer: a population-based study using the SEER 18 database. Breast Cancer Res Treat 183, 429–438 (2020). https://doi.org/10.1007/s10549-020-05776-2

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