Joachim Rom1, Claudia Schumacher2, Oleg Gluz3, Josef Höfler4, Sebastian Eidt5, Christoph Domschke1, Frederik Marmé6, Ulrike Nitz3, Christof Sohn1, Andreas Schneeweiss6. 1. Universitäts-Frauenklinik, Universität Heidelberg, Deutschland. 2. Brustzentrum, St. Elisabeth Krankenhaus, Köln, Deutschland. 3. Brustzentrum, Bethesda Krankenhaus, Wuppertal, Deutschland. 4. Staburo GmbH, München, Deutschland. 5. Institut für Pathologie, St. Elisabeth Krankenhaus, Köln, Deutschland. 6. Universitäts-Frauenklinik, Universität Heidelberg, Deutschland ; National Centrum für Tumorerkrankungen, Universität Heidelberg, Deutschland.
Abstract
BACKGROUND: There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors. PATIENTS AND METHODS: We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors. RESULTS: With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab. CONCLUSION: Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.
BACKGROUND: There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors. PATIENTS AND METHODS: We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors. RESULTS: With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab. CONCLUSION:Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.
Entities:
Keywords:
Adjuvant treatment; Disease-free survival; HER2/neu; High-risk breast cancer; Trastuzumab
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