G Houvenaeghel1, A Goncalves2, J M Classe3, J R Garbay4, S Giard5, H Charytensky6, M Cohen7, C Belichard8, C Faure9, S Uzan10, D Hudry11, P Azuar12, R Villet13, P Gimbergues14, C Tunon de Lara15, M Martino7, E Lambaudie7, C Coutant11, F Dravet3, M P Chauvet5, E Chéreau Ewald16, F Penault-Llorca17, B Esterni18. 1. Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM. Electronic address: houvenaeghelg@ipc.unicancer.fr. 2. Department of Oncology, Institut Paoli Calmettes, Aix Marseille Université, Marseille. 3. Department of Surgery, Institut René Gauducheau, Nantes. 4. Department of Surgery, Institut Gustave Roussy, Villejuif. 5. Department of Surgery, Centre Oscar Lambret, Lille. 6. Department of Surgery, Centre Claudius Regaud, Toulouse. 7. Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM. 8. Department of Surgery, Centre René Huguenin, Saint Cloud. 9. Department of Surgery, Centre Léon Bérard, Lyon. 10. Department of Surgery, Hôpital Tenon, Paris. 11. Department of Surgery, Centre Georges François Leclerc, Dijon. 12. Department of Surgery, Hôpital de Grasse, Grasse. 13. Department of Surgery, Hôpital des Diaconnesses, Paris. 14. Department of Surgery, Centre Jean Perrin, Clermont Ferrand. 15. Department of Surgery, Institut Bergonié, Bordeaux. 16. Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM; Department of Surgery, Hôpital Tenon, Paris. 17. Department of Pathology, Centre Jean Perrin, Clermont Ferrand. 18. Biostatistic, Department of Surgery, Institut Paoli Calmettes, Marseilleand CRCM, France.
Abstract
BACKGROUND: A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST). PATIENTS AND METHODS: Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized. RESULTS: Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11-15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors. CONCLUSION: Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.
BACKGROUND: A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST). PATIENTS AND METHODS: Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized. RESULTS: Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11-15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors. CONCLUSION: Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.
Entities:
Keywords:
T1N0M0; adjuvant systemic therapy; breast cancer; prognosis
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