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Adjuvant chemotherapy for pT1-3N0-1 breast cancer patients with HR+, HER2− subtype: a propensity-score matched study with competing risk analysis

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Abstract

Objective

To wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2− subtype using the Surveillance, Epidemiology, and End Results (SEER) database.

Method

A total of 126,102 eligible cases diagnosed between January 2010 and December 2018 were included in the SEER database. A propensity-score matched (PSM) study with competing risk analysis was conducted. The Kaplan–Meier method was used to visualize the survival disparities between chemotherapy (CHT) and no CHT groups. The cumulative incidences of different subgroups were compared by Fine-Gray’s test.

Results

Before PSM, patients in the CHT group had worse OS and CSS (both P < 0.001). After PSM, we were surprised that patients in the CHT group had a better OS than those in the no CHT group (HR 0.74, 95% CI 0.68–0.80, P < 0.001), while no significant survival disparities were observed for CSS (HR 1.00, 95% CI 0.89–1.12, P = 0.952). In the competing risk analysis, the OS disparities between the CHT and no CHT groups were mainly attributed to deaths of other causes (subdistribution HR [95% CI] 0.50 [0.44–0.57]). After adjusting for other competitive risk events, there was no significant difference in cumulative death risk of breast cancer between the CHT and no CHT groups (subdistribution HR [95% CI] 1.01 [0.90–0.1.13]).

Conclusion

The present study is the first, to our knowledge, to wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2− subtype using a propensity-score matched study with competing risk analysis. All pT1-3N0-1 breast cancer patients with HR+, HER2− subtype do not benefit from CHT. Genetic testing may be the only effective tool to determine the need for CHT at the present.

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Data availability statement

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.

Abbreviations

SEER:

Surveillance, epidemiology, and end results

PSM:

Propensity-score matched

CHT:

Chemotherapy

HR:

Hormone receptor

HER2:

Human epidermal growth factor receptor 2

OS:

Overall survival

CSS:

Cancer specific survival

ICD-O-3:

The 3rd edition of International Classification of Diseases for Oncology

AJCC:

American Joint Committee on Cancer

SMDs:

Standardized mean differences

HRs:

Hazard ratios

Cis:

Confidence intervals

C-index:

Concordance index

IQR:

Interquartile range

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Funding

Wuhan Municipal Health Commission, Grant/Award Number: WX19Q49; Health Commission of Hubei province, Grant/Award Number: WJ2019H396; Wuhan Medical Scientific Research Project: WX21D69.

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Author notes

  1. Hong Dong and Xinyu Su contributed equally.

Authors and Affiliations

  1. Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Lun Tan

  2. Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Hong Dong

  3. Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China

    Xinyu Su, Xun Li & Peng Fu

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  1. Hong Dong
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  5. Lun Tan
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Contributions

Dr HD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: HD, LT. Acquisition, analysis, or interpretation of data: HD, XS. Statistical analysis: HD, XL, PF. Drafting of the manuscript: HD, LT. Supervision: LT.

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Correspondence to Lun Tan.

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Dong, H., Su, X., Li, X. et al. Adjuvant chemotherapy for pT1-3N0-1 breast cancer patients with HR+, HER2− subtype: a propensity-score matched study with competing risk analysis. J Cancer Res Clin Oncol 149, 12637–12646 (2023). https://doi.org/10.1007/s00432-023-05124-z

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