早期三阴性乳腺癌的术后辅助化疗
肿瘤≤2厘米（T1）淋巴结阴性（N0）无远处转移（M0）的乳腺癌患者被认为预后良好，即使对于无复发生存和总生存通常较差的三阴性乳腺癌。虽然目前化疗仍为三阴性乳腺癌的唯一辅助治疗方法，但是术后辅助化疗有益于T1N0M0三阴性乳腺癌患者的证据有限。
2018年12月5日，欧洲乳腺癌专科学会《乳腺》在线发表复旦大学附属肿瘤医院任毅行、金希、叶富贵、龚悦、江一舟、邵志敏等学者的研究报告，评估了T1N0M0三阴性乳腺癌患者辅助化疗的作用和紫杉类的获益。
该研究于2008年1月～2015年12月从复旦大学附属肿瘤医院入组连续354例新诊断为T1N0M0三阴性乳腺癌患者，通过单因素和多因素生存分析，对有、无紫杉类的辅助化疗患者生存进行比较。
结果，随访时间中位45个月，其中化疗患者占92.4%。有、无辅助化疗患者的5年无复发生存率分别为94.5%、83.6%。根据多因素分析，辅助化疗和未侵犯淋巴血管，与无复发生存显著获益相关。
根据亚组分析，有、无辅助化疗相比：
T1c患者无复发生存获益显著（风险比：0.24，95%置信区间：0.08～0.76，P=0.014）
T1b患者无复发生存获益相似（风险比：0.32，95%置信区间：0.03～3.18，P=0.330）
对于T1N0M0三阴性乳腺癌患者，蒽环类±紫杉类相比，无复发生存相似。
因此，该研究结果表明，T1c与T1b三阴性乳腺癌患者相比，辅助化疗可以显著改善无复发生存，对于T1b三阴性乳腺癌患者可以考虑免去辅助化疗。对于T1N0M0三阴性乳腺癌患者，将紫杉类加入蒽环类辅助化疗的无复发生存获益不显著，无紫杉类的蒽环类辅助化疗方案可能足以实现T1N0M0三阴性乳腺癌患者无复发生存获益。
Breast. 2018 Dec 5;43:97-104. [Epub ahead of print]
Effects of adjuvant chemotherapy in T1N0M0 triple-negative breast cancer.
Yi-Xing Ren, Shuang Hao, Xi Jin, Fu-Gui Ye, Yue Gong, Yi-Zhou Jiang, Zhi-Ming Shao.
Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Institutes of Biomedical Science, Fudan University, Shanghai, China.
HIGHLIGHTS
Adjuvant chemotherapy improves recurrence-free survival in T1c TNBC but not in T1b.
It might be considered to omit adjuvant chemotherapy in T1bN0M0 TNBC patients.
No significant RFS benefit is achieved from adding taxane in T1N0M0 TNBC patients.
OBJECTIVES: Patients with T1N0M0 breast cancers are considered to have an excellent prognosis, even in triple-negative breast cancer (TNBC), which is often associated with diminished recurrence-free survival (RFS) and overall survival. Chemotherapy remains the only adjuvant treatment for TNBC, but evidence that adjuvant chemotherapy is beneficial for stage T1N0M0 TNBC patients is limited. In this study, we aimed to evaluate the effect of adjuvant chemotherapy and the benefit of taxanes in T1N0M0 TNBC patients.
MATERIAL AND METHODS: A cohort of 354 consecutive patients with newly diagnosed T1N0M0 TNBC between January 2008 and December 2015 were included from the Fudan University Shanghai Cancer Center. Univariate and multivariate survival analyses were performed to compare patients treated with adjuvant chemotherapy with/without taxane addition.
RESULTS: Median follow-up was 45 months. Chemotherapy was used in 92.4% of patients. The 5-year estimated RFS rates of patients with and without adjuvant chemotherapy were 94.5% and 83.6%, respectively. In multivariate analysis, adjuvant chemotherapy and a lack of lymphovascular invasion were associated with a significant benefit for RFS. A significant RFS benefit from adjuvant chemotherapy was observed in T1c (hazard ratio, HR=0.24, 95% CI [0.08–0.76], P=0.014) but not in T1b (HR=0.32, 95% CI [0.03–3.18], P=0.330) subgroups. Addition of taxane to an anthracycline-based regimen was not significantly associated with improved RFS in T1N0M0 TNBC patients.
CONCLUSION: Adjuvant chemotherapy improves recurrence-free survival in T1c TNBC patients but not in T1b. Anthracycline-based taxane-free regimens might be sufficient to achieve RFS benefits in T1N0M0 TNBC patients.
KEYWORDS: Adjuvant chemotherapy, Triple-negative breast cancer, Recurrence-free survival, T1N0M0 breast cancer, Taxane
DOI: 10.1016/j.breast.2018.11.011
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