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Adjuvant chemotherapy in patients with ER-negative/HER2-negative, T1abN0 breast cancer: a nationwide study

  • Epidemiology
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Abstract

Purpose

The purpose of this study was to examine the effect of chemotherapy on invasive disease-free survival (iDFS) and overall survival (OS) in a nationwide cohort of patients with estrogen receptor (ER)-negative/human epidermal growth factor receptor 2 (HER2)-negative, T1abN0 breast cancer.

Methods

Patients with ER-negative/HER2-negative, T1abN0 breast cancer registered in the Danish Breast Cancer Group database between 2007 and 2016 were identified. The effect of adjuvant chemotherapy on iDFS and OS was analyzed with Cox proportional hazards analysis.

Results

In total, 296 patients were included in the statistical analyses. Of these, 235 (79.4%) received chemotherapy and 61 patients (20.6%) did not. Patients treated with chemotherapy were significantly younger, had a significantly higher proportion of grade 3 tumors, T1b tumors, and tumors of ductal subtype. With 7.7 years of median follow-up, treatment with chemotherapy was associated with a significant improvement in OS in the adjusted analysis, Hazard Ratio 0.35 (95% Confidence Interval (0.15–0.81), p = 0.02), chemotherapy vs. no chemotherapy. In the unadjusted analyses, patients with both T1a and T1b tumors had significantly improved OS with chemotherapy. At 5 years, OS was 100% vs. 94.4% and 93.8% vs. 81.3% for patients with T1a and T1b tumors, respectively, chemotherapy vs. no chemotherapy. With 4.9 years of median follow-up, iDFS was not significantly improved with chemotherapy.

Conclusion

Patients with ER-negative/HER2-negative, T1abN0 breast cancer had significantly improved OS when treated with chemotherapy. This improvement was significant in patients with both T1a and T1b tumors, respectively. The effect was, however, limited in patients with T1a tumors.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to Danish legislation. Access to data from the Danish Breast Cancer Group database can be applied through Danish Clinical Registries (RKKP).

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Funding

This study is part of a PhD-project supported by the Danish Cancer Society, Denmark (R246-A14574-19-S73); Interne Forskningsmidler, Herlev and Gentofte Hospital, Denmark; Tømrermester Jørgen Holm og Hustru Elisa F. Hansens Mindelegat, Denmark (20006-1846); Dansk Kræftforskningsfond, Denmark; Region Sjællands Sundhedsvidenskabelige Forskningsfond, Denmark (R19A283B198); Dansk Brystkirurgisk Selskabs legat, Denmark; Helsefonden, Denmark (20-B-0003). The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. All authors were involved in material preparation, data collection, analysis, or interpretation of the analyses. The first draft of the manuscript was written by CH and TT. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christina M. S. Hassing.

Ethics declarations

Competing interests

Ann Søegaard Knoop reports personal fees from Novartis, Roche, Merck, Daiichi Sankyo, Gilead Sciences, Pfizer, Eli Lilly. Furthermore, she has been national or site investigator for Daiichi Sankyo and Sanofi. Tove Tvedskov reports speaker honorariums from Roche, MSD and Pfizer. Anne-Vibeke Lænkholm reports institutional research grants from Novartis and Astra Zeneca (AZ). Anne-Vibeke Lænkholm reports personal fees for participation in advisory boards, Novartis and AZ and for a research collaboration with Veracyte. No other potential conflicts of interest were reported.

Ethical approval

This study was approved by the Regional Research Ethics Committee of the Capital Region of Denmark (H-18045702) and by the Regional Data Protection Agency (P-2019-124).

Informed consent

Exception for obtaining informed consent was given by the Regional Research Ethics Committee of the Capital Region of Denmark as the present study implied no health-related risks or discomfort for the involved patients.

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Hassing, C.M.S., Mejdahl, M.K., Lænkholm, AV. et al. Adjuvant chemotherapy in patients with ER-negative/HER2-negative, T1abN0 breast cancer: a nationwide study. Breast Cancer Res Treat 198, 103–112 (2023). https://doi.org/10.1007/s10549-022-06839-2

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