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Observational Study
. 2014 Jul 10;32(20):2142-50.
doi: 10.1200/JCO.2013.53.1608. Epub 2014 Jun 2.

Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study

Ines Vaz-Luis  1 , Rebecca A Ottesen  1 , Melissa E Hughes  1 , Rizvan Mamet  1 , Harold J Burstein  1 , Stephen B Edge  1 , Ana M Gonzalez-Angulo  1 , Beverly Moy  1 , Hope S Rugo  1 , Richard L Theriault  1 , Jane C Weeks  1 , Eric P Winer  1 , Nancy U Lin  2
Affiliations
Observational Study

Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study

Ines Vaz-Luis et al. J Clin Oncol. .

Abstract

Purpose: Treatment decisions for patients with T1a,bN0M0 breast cancer are challenging. We studied the time trends in use of adjuvant chemotherapy and survival outcomes among these patients.

Patients and methods: This was a prospective cohort study within the National Comprehensive Cancer Network Database that included 4,113 women with T1a,bN0M0 breast cancer treated between 2000 and 2009. Tumors were grouped by size (T1a, T1b), biologic subtype defined by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, and receipt of chemotherapy with or without trastuzumab.

Results: Median follow-up time was 5.5 years. Eight percent of patients with HR-positive/HER2-negative tumors were treated with chemotherapy. Fifty-two percent of those with HER2-positive or HR-negative/HER2-negative breast cancers received chemotherapy, with an increase over the last decade. Survival outcomes diverged by subtype and size, but the 5-year distant relapse-free survival (DRFS) did not exceed 10% in any subgroup. The 5-year DRFS for patients with T1a tumors untreated with chemotherapy ranged from 93% to 98% (n = 49 to 972), and for patients with T1b tumors, it ranged from 90% to 96% (n = 17 to 2,005). Patients with HR-positive/HER2-negative disease had the best DRFS estimates, and patients with HR-negative/HER2-negative tumors had the lowest. In this observational, nonrandomized cohort study, the 5-year DRFS for treated patients with T1a tumors was 100% for all subgroups (n = 12 to 33), and for patients with T1b tumors, it ranged from 94% to 96% (n = 88 to 241).

Conclusion: Women with T1a,b tumors have an excellent prognosis without chemotherapy. Size and tumor subtype may identify patients in whom the rate of recurrence justifies consideration of chemotherapy. These patients represent an optimal group for evaluating less toxic adjuvant regimens to maintain efficacy while minimizing short- and long-term risks.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Flow diagram of patient population. HER2, human epidermal growth factor receptor 2; HR, hormone receptor; NCCN: National Comprehensive Cancer Network.
Fig 2.
Fig 2.
Distant relapse-free survival of T1a,bN0 patients with breast cancer, National Comprehensive Cancer Network, 2000 to 2009. (A) HR-positive/HER2-negative group; (B) HR-positive/HER2-positive group; (C) HR-negative/HER2-negative group; (D) HR-negative/HER2-positive group. HR, hormone receptor; HER2, human epidermal growth factor receptor 2.
Fig 2.
Fig 2.
Distant relapse-free survival of T1a,bN0 patients with breast cancer, National Comprehensive Cancer Network, 2000 to 2009. (A) HR-positive/HER2-negative group; (B) HR-positive/HER2-positive group; (C) HR-negative/HER2-negative group; (D) HR-negative/HER2-positive group. HR, hormone receptor; HER2, human epidermal growth factor receptor 2.
Fig A1.
Fig A1.
Distant relapse-free survival of patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative T1a,bN0 breast cancer by histologic grade, National Comprehensive Cancer Network, 2000 to 2009. (A) Patients who did not receive chemotherapy; (B) patients who received chemotherapy.
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