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Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer

  • Epidemiology
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Abstract

Introduction

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.

Methods

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.

Results

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 (Pinteraction=0.024); moreover, the benefit in BCSS was similar in all subgroups.

Conclusions

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.

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Data Availability

This study was conducted using matrices obtained from SEER*Stat 8.4.0.1. We collected the data from the SEER database research plus the 2022 submission. The spreadsheet created for the data analysis is available for the public after a request for SEER software from the NCI is granted. The selection criteria necessary to obtain the matrix we used for this study are specified in the methods section of the manuscript.

Abbreviations

BCS:

Breast-conserving surgery

BCSS:

Breast cancer-specific survival

CIF:

Cumulative incidence functions

CIs:

Confidence intervals

ER:

Estrogen-receptor

HER2:

Human epidermal growth factor receptor 2

HRs:

Hazard ratios

ICD:

International Classification of Disease

NCCN:

National Comprehensive Cancer Network

NHB:

Non-Hispanic Black

NHW:

Non-Hispanic White

OR:

Odds ratio

OS:

Overall survival

PR:

Progesterone-receptor

RFS:

Recurrence-free survival

SEER:

Surveillance, Epidemiology, and End Results

TNBC:

Triple-negative breast cancer

References

  1. Wolff AC et al (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: american society of clinical Oncology/College of american pathologists clinical practice guideline update. J Clin Oncol 31(31):3997–4013

    Article  PubMed  Google Scholar 

  2. Hammond ME et al (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28(16):2784–2795

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dawson SJ, Provenzano E, Caldas C (2009) Triple negative breast cancers: clinical and prognostic implications. Eur J Cancer 45(Suppl 1):27–40

    Article  PubMed  Google Scholar 

  4. Bray F et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  PubMed  Google Scholar 

  5. Siegel RL et al (2022) Cancer statistics, 2022. CA Cancer J Clin 72(1):7–33

    Article  PubMed  Google Scholar 

  6. Haffty BG et al (2006) Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol 24(36):5652–5657

    Article  PubMed  Google Scholar 

  7. Dent R et al (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13(15 Pt 1):4429–4434

    Article  PubMed  Google Scholar 

  8. Johansson ALV et al (2019) Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort. Int J Cancer 144(6):1251–1261

    Article  CAS  PubMed  Google Scholar 

  9. Chaudhary LN (2020) Early stage triple negative breast cancer: management and future directions. Semin Oncol 47(4):201–208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Anampa J, Makower D, Sparano JA (2015) Progress in adjuvant chemotherapy for breast cancer: an overview. BMC Med 13:195

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lu JY, Alvarez Soto A, Anampa JD (2022) The landscape of systemic therapy for early stage triple-negative breast cancer. Expert Opin Pharmacother 23(11):1291–1303

    Article  PubMed  Google Scholar 

  12. Bonadonna G et al (1976) Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 294(8):405–410

    Article  CAS  PubMed  Google Scholar 

  13. Early Breast Cancer Trialists’, Collaborative G et al (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379(9814):432–444

    Article  Google Scholar 

  14. Autier P, Boniol M (2018) Mammography screening: a major issue in medicine. Eur J Cancer 90:34–62

    Article  PubMed  Google Scholar 

  15. Vaz-Luis I et al (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

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bao J et al (2019) Outcomes in patients with small node-negative invasive breast cancer. Breast J 25(4):638–643

    Article  CAS  PubMed  Google Scholar 

  17. Ho AY et al (2012) Favorable prognosis in patients with T1a/T1bN0 triple-negative breast cancers treated with multimodality therapy. Cancer 118(20):4944–4952

    Article  PubMed  Google Scholar 

  18. Lai HW et al (2011) Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller. Eur J Surg Oncol 37(1):18–24

    Article  CAS  PubMed  Google Scholar 

  19. An X et al (2020) Adjuvant chemotherapy for small, lymph node-negative, triple-negative breast cancer: a single-center study and a meta-analysis of the published literature. Cancer 126:3837–3846

    Article  CAS  PubMed  Google Scholar 

  20. Gradishar WJ et al (2022) Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 20(6):691–722

    Article  PubMed  Google Scholar 

  21. Curigliano G et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the primary therapy of early breast Cancer 2017. Ann Oncol 28(8):1700–1712

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Steenbruggen TG et al (2020) Adjuvant chemotherapy in small node-negative triple-negative breast cancer. Eur J Cancer 135:66–74

    Article  CAS  PubMed  Google Scholar 

  23. Hanrahan EO et al (2007) Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma. J Clin Oncol 25(31):4952–4960

    Article  PubMed  Google Scholar 

  24. Stuber T et al (2017) Are there breast Cancer patients with node-negative small tumours, who do not benefit from Adjuvant systemic therapy? Oncology 92(6):317–324

    Article  PubMed  Google Scholar 

  25. Migdady Y et al (2013) Adjuvant chemotherapy in T1a/bN0 HER2-positive or triple-negative breast cancers: application and outcomes. Breast 22(5):793–798

    Article  PubMed  Google Scholar 

  26. Lan T et al (2021) The role of chemotherapy in patients with T1bN0M0 triple-negative breast cancer: a real-world competing risk analysis. J Cancer 12(1):10–17

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Fasano GA et al (2022) Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 192(1):163–173

    Article  CAS  PubMed  Google Scholar 

  28. Houvenaeghel G et al (2014) Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study. Ann Oncol 25(3):623–628

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Leon-Ferre RA et al (2018) Impact of histopathology, tumor-infiltrating lymphocytes, and adjuvant chemotherapy on prognosis of triple-negative breast cancer. Breast Cancer Res Treat 167(1):89–99

    Article  CAS  PubMed  Google Scholar 

  30. Pistelli M et al (2013) Prognostic factors in early-stage triple-negative breast cancer: lessons and limits from clinical practice. Anticancer Res 33(6):2737–2742

    CAS  PubMed  Google Scholar 

  31. Ren YX et al (2019) Effects of adjuvant chemotherapy in T1N0M0 triple-negative breast cancer. Breast 43:97–104

    Article  PubMed  Google Scholar 

  32. Zhai Z et al (2020) Evaluation of adjuvant treatments for T1 N0 M0 triple-negative breast Cancer. JAMA Netw Open 3(11):e2021881

    Article  PubMed  PubMed Central  Google Scholar 

  33. Doll KM, Rademaker A, Sosa JA (2018) Practical guide to Surgical Data sets: Surveillance, Epidemiology, and end results (SEER) database. JAMA Surg 153(6):588–589

    Article  PubMed  Google Scholar 

  34. Griggs JJ et al (2012) Factors associated with receipt of breast cancer adjuvant chemotherapy in a diverse population-based sample. J Clin Oncol 30(25):3058–3064

    Article  PubMed  PubMed Central  Google Scholar 

  35. Liu YL et al (2019) Marital status is an independent prognostic factor in inflammatory breast cancer patients: an analysis of the surveillance, epidemiology, and end results database. Breast Cancer Res Treat 178(2):379–388

    Article  PubMed  PubMed Central  Google Scholar 

  36. Du ZL et al (2020) 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(2):429–438

    Article  CAS  PubMed  Google Scholar 

  37. Tao L et al (2019) Breast Cancer mortality in older and younger patients in California. Cancer Epidemiol Biomarkers Prev 28(2):303–310

    Article  CAS  PubMed  Google Scholar 

  38. Prakash O et al (2020) Racial disparities in Triple negative breast Cancer: a review of the role of Biologic and non-biologic factors. Front Public Health 8:576964

    Article  PubMed  PubMed Central  Google Scholar 

  39. Newman LA et al (2006) Meta-analysis of survival in african american and white american patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol 24(9):1342–1349

    Article  PubMed  Google Scholar 

  40. Chlebowski RT et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97(6):439–448

    Article  PubMed  Google Scholar 

  41. Welch HG et al (2016) Breast-Cancer tumor size, overdiagnosis, and Mammography Screening effectiveness. N Engl J Med 375(15):1438–1447

    Article  PubMed  Google Scholar 

  42. Jasra S, Anampa J (2018) Anthracycline Use for early stage breast Cancer in the modern era: a review. Curr Treat Options Oncol 19(6):30

    Article  PubMed  Google Scholar 

  43. Early Breast Cancer Trialists’ Collaborative Group. Electronic address, b.o.c.o.a.u. and G. Early Breast Cancer Trialists’ Collaborative, Anthracycline-containing and taxane-containing chemotherapy for early-stage operable breast cancer: a patient-level meta-analysis of 100 000 women from 86 randomised trials. Lancet (2023) 401(10384): p. 1277–1292

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Acknowledgements

The manuscript development is supported by The Einstein Paul Calabresi Career Development Program (NIH 5K12CA132783-08) and NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA (Grant Number UL1TR001073).

Funding

The authors declare that no funds or grants were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Medical Oncology, Catalan Institute of Oncology/Josep Trueta Hospital, Girona, Spain

    Walter Carbajal-Ochoa

  2. Department of Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, NY, USA

    Daniela C. Bravo-Solarte

  3. Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA

    Ana M. Bernal & Jesus D. Anampa

Authors
  1. Walter Carbajal-Ochoa
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  2. Daniela C. Bravo-Solarte
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  3. Ana M. Bernal
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  4. Jesus D. Anampa
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Contributions

All authors contributed to this study’s conception and design. WC performed study design, data collection, table/graphics creation, data interpretation, statistical analysis, and manuscript drafting; DBS performed data collection, data analysis, and manuscript drafting, AB contributed to data collection, table/graphics creation, material preparation, manuscript preparation, JA participated in study conception, study design, data collection, data analysis, data interpretation, and manuscript writing. All authors reviewed and approved the final draft.

Corresponding author

Correspondence to Jesus D. Anampa.

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Competing interests

All authors declare no conflict of interest during the preparation of this manuscript.

Ethics approval

This study was approved by the Institutional Board Review (IRB) of the Albert Einstein College of Medicine. Due to the retrospective nature of this study, no informed consent was required.

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Carbajal-Ochoa, W., Bravo-Solarte, D.C., Bernal, A.M. et al. Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 203, 257–269 (2024). https://doi.org/10.1007/s10549-023-07132-6

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  • DOI: https://doi.org/10.1007/s10549-023-07132-6

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