Skip to main content

Advertisement

SpringerLink
Log in

Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer

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

Abstract

Purpose

National comprehensive cancer network guidelines recommend delivery of adjuvant chemotherapy in node-negative triple-negative breast cancer (TNBC) if the tumor is > 1 cm and consideration of adjuvant chemotherapy for T1b but not T1a disease. These recommendations are based upon sparse data on the role of adjuvant chemotherapy in T1a and T1b node-negative TNBC. Our objective was to clarify the benefits of chemotherapy for patients with T1N0 TNBC, stratified by tumor size.

Methods

We performed a retrospective analysis of survival outcomes of TNBC patients at two academic institutions in the United States from 1999 to 2018. Primary tumor size, histology, and nodal status were based upon surgical pathology. The Kaplan–Meier plot and 5-year unadjusted survival probability were evaluated.

Results

Among 282 T1N0 TNBC cases, the status of adjuvant chemotherapy was known for 258. Mean follow-up was 5.3 years. Adjuvant chemotherapy was delivered to 30.5% of T1a, 64.7% T1b, and 83.9% T1c (p < 0.0001). On multivariable analysis, factors associated with delivery of adjuvant chemotherapy were tumor size and grade 3 disease. Improved overall survival was associated with use of chemotherapy in patients with T1c disease (93.2% vs. 75.2% p = 0.008) but not T1a (100% vs. 100% p = 0.3778) or T1b (100% vs. 95.8% p = 0.2362) disease.

Conclusion

Our data support current guidelines indicating benefit from adjuvant chemotherapy in node-negative TNBC associated with T1c tumors but excellent outcomes were observed in the cases of T1a and T1b disease, regardless of whether adjuvant chemotherapy was delivered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. 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 

  2. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, Lickley LA, Rawlinson E, Sun P, Narod SA (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13(15 Pt 1):4429–4434. https://doi.org/10.1158/1078-0432

    Article  PubMed  Google Scholar 

  3. Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, Harris L, Hait W, Toppmeyer D (2006) Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol 24(36):5652–5657. https://doi.org/10.1200/JCO.2006.06.5664

    Article  PubMed  Google Scholar 

  4. Cancello G, Masionneuve P, Rotmensz N, Viale G, Mastropasqua MG, Pruneri G, Montagna E, Dellapasqua S, Iorfida M, Cardillo A, Veronesi P, Luini A, Intra M, Gentilini O, Scarano E, Goldhirsch A, Colleoni M (2011) Prognosis in women with small (T1mic, T1a, T1b) node-negative operable breast cancer by immunohistochemically selected subtypes. Breast Cancer Res Treat 127(3):713–720. https://doi.org/10.1007/s10549-011-1465-7

    Article  CAS  PubMed  Google Scholar 

  5. Bao J, Donovan C, Amersi F, Zhang X, Giuliano AE, Chung A (2019) Outcomes in patients with small node-negative invasive breast cancer. Breast J 25(4):638–643. https://doi.org/10.1111/tbj.13288

    Article  CAS  PubMed  Google Scholar 

  6. Ho AY, Gupta G, King TA, Perez CA, Patil SM, Rogers KH, Wen YH, Brogi E, Morrow M, Hudis CA, Traina T, McCormick B, Powell SN, Robson ME (2012) Favorable prognosis in patients with T1a/T1bN0 triple-negative breast cancers treated with multimodality therapy. Cancer 118(20):4944–4952. https://doi.org/10.1002/cncr.27480

    Article  PubMed  Google Scholar 

  7. An X, Lei X, Huang R, Luo R, Li H, Xu F, Yuan Z, Wang S, de Nonneville A, Gonçalves A, Houvenaeghel G, Li J, Xue C, Shi Y (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 Suppl 16:3837–3846. https://doi.org/10.1002/cncr.32878

    Article  CAS  Google Scholar 

  8. Newman LA, Reis-Filho JS, Morrow M, Carey LA, King TA (2014) The 2014 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: triple-negative breast cancer. Ann Surg Oncol 22(3):874–82. https://doi.org/10.1245/s10434-014-4279-0

  9. Bellio G, Marion R, Giudici F, Kus S, Tonutti M, Zanconati F, Bortul M (2017) Interval breast cancer versus screen-detected cancer: comparison of clinicopathologic characteristics in a single-center analysis. Clin Breast Cancer 17(7):564–571. https://doi.org/10.1016/j.clbc.2017.04.001

    Article  PubMed  Google Scholar 

  10. O’Brien KM, Mooney T, Fitzpatrick P, Sharp L (2018) Screening status, tumor subtype, and breast cancer survival: a national population-based analysis. Breast Cancer Res Treat 172(1):133–142. https://doi.org/10.1007/s10549-018-4877-9

    Article  PubMed  Google Scholar 

  11. National Comprehensive Cancer Network (2021) Breast cancer (version 7.2021). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 31 August 2021

  12. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JM, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, Paik S, Perez EA, Press MF, Spears PA, Vance GH, Viale G, Hayes DF (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. https://doi.org/10.1200/JCO.2013.50.9984.

  13. Giuliano AE, Edge SB, Hortobagyi GN (2018) Eighth edition of the AJCC cancer staging manual: breast cancer. Ann Surg Oncol 25(7):1783–1785. https://doi.org/10.1245/s10434-018-6486-6

    Article  PubMed  Google Scholar 

  14. Colonna SV, Higgins AK, Alvarez J, Saville BR, Lawrence J, Abramson VG (2015) Analysis of risk of recurrence by subtype in ≤ 1-cm breast tumors. Clin Breast Cancer 16(3):223–231. https://doi.org/10.1016/j.clbc.2015.10.001

    Article  PubMed  Google Scholar 

  15. 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 

  16. Zhai Z, Zheng Y, Yao J, Liu Y, Ruan J, Deng Y, Zhou L, Zhao P, Yang S, Hu J, We B, Wu Y, Zhang D, Kang H, Dai Z (2020) Evaluation of adjuvant treatments for T1 N0 M0 triple-negative breast cancer. JAMA Netw Open 3(11):e2021881. https://doi.org/10.1001/jamanetworkopen.2020.21881

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yang Z, Chen Y, Liu X, Cui J, Hu Y, Wei W (2020) Effects of adjuvant chemotherapy on recurrence rate in T1abN0M0 triple-negative breast cancer: a meta-analysis. Cancer Treat Res Commun 25:100211. https://doi.org/10.1016/j.ctarc.2020.100211

    Article  PubMed  Google Scholar 

  18. Steenbruggen TG, van Werkhoven E, van Ramshorst MS, Dezentjé VO, Kok M, Linn SC, Siesling S, Sonke GS (2020) Adjuvant chemotherapy in small node-negative triple-negative breast cancer. Eur J Cancer 135:66–74. https://doi.org/10.1016/j.ejca.2020.04.033

    Article  CAS  PubMed  Google Scholar 

  19. De Boniface J, Szulkin R, Johansson A (2021) Survival after breast conservation vs mastectomy adjusted for comorbidity and socioeconomic status: a Swedish national 6-year follow-up of 48986 women. JAMA Surg 156(7):628–637. https://doi.org/10.1001/jamasurg.2021.1438

    Article  PubMed  PubMed Central  Google Scholar 

  20. Newman LA (2021) Safety of breast-conserving surgery in breast cancer and risk of overtreatment vs undertreatment. JAMA Surg 156(7):638. https://doi.org/10.1001/jamasurg.2021.1450

    Article  PubMed  Google Scholar 

  21. McVeigh TP, Kerin MJ (2017) Clinical use of the Oncotype DX genomic test to guide treatment decisions for patients with invasive breast cancer. Breast Cancer 9:393–400. https://doi.org/10.2147/BCTT.S109847

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Buyse M, Loi S, van’t Veer L, Viale G, Delorenzi M, Glas AM, d’Assignies MS, Bergh J, Lidereau R, Ellis P, Harris A, Bogaerts J, Therasse P, Floore A, Amakrane M, Piette F, Rutgers E, Sotiriou C, Cardoso F, Piccart MJ, (2006) Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst 98(17):1183–1192. https://doi.org/10.1093/jnci/djj329

    Article  CAS  PubMed  Google Scholar 

  23. Lehmann BD, Bauer JA, Chen X, Sanders ME, Chakravarthy AB, Shyr Y, Pietenpol JA (2011) Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 121(7):2750–2767. https://doi.org/10.1172/JCI45014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Santonja A, Sánchez-Muñoz A, Lluch A, Chica-Parrado MR, Albanell J, Chacón JI, Antolín S, Jerez JM, de la Haba J, de Luque V, Fernández-De Sousa CE, Vicioso L, Plata Y, Ramírez-Tortosa CL, Álvarez M, Llácer C, Zarcos-Pedrinaci I, Carrasco E, Caballero R, Martín M, Alba E (2018) Triple negative breast cancer subtypes and pathologic complete response rate to neoadjuvant chemotherapy. Oncotarget 9(41):26406–26416. https://doi.org/10.18632/oncotarget.25413

  25. Denkert C, von Minckwitz G, Darb-Esfahani S, Lederer B, Heppner BI, Weber KE, Budczies J, Huober J, Klauschen F, Furlanetto J, Schmitt WD, Blohmer JU, Karn T, Pfitzner BM, Kümmel S, Engels K, Schneeweiss A, Hartmann A, Noske A, Fasching PA, Jackisch C, van Mackelenbergh M, Sinn P, Schem C, Hanusch C, Untch M, Loibl S (2018) Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy. Lancet Oncol 1:40–50. https://doi.org/10.1016/S1470-2045(17)30904-X

    Article  Google Scholar 

  26. Loi S, Drubay D, Adams S, Pruneri G, Francis PA, Lacroix-Triki M, Joensuu H, Dieci MV, Badve S, Demaria S, Gray R, Munzone E, Lemonnier J, Sotiriou C, Piccart MJ, Kellokumpu-Lehtinen PL, Vingiani A, Gray K, Andre F, Denkert C, Salgado R, Michiels S (2019) Tumor-infiltrating lymphocytes and prognosis: a pooled individual patient analysis of early-stage triple-negative breast cancers. J Clin Oncol 37(7):559–569. https://doi.org/10.1200/JCO.18.01010

    Article  PubMed  PubMed Central  Google Scholar 

  27. Keenan TE, Tolaney SM (2020) Role of immunotherapy in triple-negative breast cancer. J Natl Compr Canc Netw 18(4):479–489. https://doi.org/10.6004/jnccn.2020.7554

    Article  CAS  PubMed  Google Scholar 

  28. Hida AI, Watanabe T, Sagara Y, Kashiwaba M, Sagara Y, Aogi K, Ohi Y, Tanimoto A (2019) Diffuse distribution of tumor-infiltrating leukocytes is a marker for better prognosis and chemotherapeutic effect in triple-negative breast cancer. Breast Cancer Res Treat 178(2):283–294.

  29. Adams S, Gray RJ, Demaria S, Goldstein L, Perez EA, Shulman LN, Martino S, Wang M, Jones VE, Saphner TJ, Wolff C, Wood WC, Davidson NE, Sledge GW, Sparano JA, Badve SS (2014) Prognostic value of tumor-infiltrating lymphocytes in triple-negative breast cancers from two phase III randomized adjuvant breast cancer trials: ECOG 2197 and ECOG 1199. J Clin Oncol 32(27):2959–2966. https://doi.org/10.1200/JCO.2013.55.0491

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Dr. Newman receives funding from Susan G. Komen (Grant Number SAC 160072) and Fashion Footwear Association of New York Charitable Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY, USA

    Genevieve A. Fasano, Solange Bayard, Rache Simmons, Alexander Swistel, Jennifer Marti, Melissa Davis & Lisa Newman

  2. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    Yalei Chen

  3. Department of Medical Oncology, New York Presbyterian – Weill Cornell Medicine, New York, NY, USA

    Leticia Varella, Tessa Cigler, Anne Moore & Eleni Andreopoulou

  4. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    Jessica Bensenhaver & Haythem Ali

  5. Department of Radiation Oncology, New York Presbyterian – Weill Cornell Medicine, New York, NY, USA

    John Ng, Andrew Brandmaier & Silvia Formenti

Authors
  1. Genevieve A. Fasano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Solange Bayard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yalei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leticia Varella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tessa Cigler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica Bensenhaver
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rache Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexander Swistel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jennifer Marti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anne Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eleni Andreopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. John Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Andrew Brandmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Silvia Formenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Haythem Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Melissa Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Lisa Newman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LN and YC designed the study. GF, SB, YC, LV, TC, RS, AS, JM, AM, EA, JN, AB, SF, HA, and MD were involved in the methodology. Data collection and analysis were performed by GF, SB, YC, and LN. The first draft of the manuscript was written by GF, and all authors commented on the previous versions of the manuscript. All authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to Lisa Newman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Consent for publication of the work contained in the manuscript was obtained by all authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fasano, G.A., Bayard, S., Chen, Y. et al. Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 192, 163–173 (2022). https://doi.org/10.1007/s10549-021-06481-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-021-06481-4

Keywords

Search

Navigation