早期淋巴结阴性三阴性乳腺癌术后化疗

　　现有指南推荐对肿瘤>5毫米（T1b期）淋巴结阴性三阴性乳腺癌患者进行术后辅助化疗，不过支持该推荐意见的临床证据较少。

　　2020年7月25日，美国癌症学会《癌症》中国乳腺癌特刊在线发表中国肿瘤医学协同创新中心、中山大学附属肿瘤医院、昆明医科大学第二附属医院、法国马赛大学保利卡梅特斯癌症研究中心的临床研究和已发表文献荟萃分析报告，探讨了肿瘤大小不同T1N0M0期（测量值≤2厘米）三阴性乳腺癌患者术后辅助化疗的生存获益。

　　该单中心回顾研究首先对2000年1月～2016年12月中山大学附属肿瘤医院连续351例病理T1N0M0期三阴性乳腺癌患者进行回顾分析，随后通过医学文献数据库对辅助化疗影响目标人群的全部研究进行检索和荟萃分析。

　　结果，351例患者其中309例（88%）接受了辅助化疗，42例（12%）未接受辅助化疗。

　　肿瘤大小分布：

• T1a期：19例（5.4%）

• T1b期：67例（19.1%）

• T1c期：265例（75.5%）

　　辅助化疗与未辅助化疗相比：

• T1a期：患者复发死亡风险相似（风险比：3.99，95%置信区间：0.05～317.5，P=0.535）

• T1b期：患者复发死亡风险相似（风险比：0.64，95%置信区间：0.53～7.74，P=0.724）

• T1c期：患者复发死亡风险较低（风险比：0.006，95%置信区间：0.001～0.03，P<0.001）

　　T1c期患者接受不同化疗方案的复发死亡风险相似。

　　文献检索发现7项研究符合要求，包括T1N0M0期患者1525例（T1a/bN0M0期941例）。

　　荟萃分析表明，辅助化疗与未辅助化疗相比：

• T1a期：复发风险相似（风险比：0.64，95%置信区间：0.31～1.33，P=0.23）

• T1b期：复发风险低38%（风险比：0.62，95%置信区间：0.42～0.92，P<0.05）

　　因此，该研究结果表明，虽然回顾分析表明辅助化疗仅对T1cN0期三阴性乳腺癌患者有生存获益，但是荟萃分析表明辅助化疗对T1bN0期三阴性乳腺癌患者也有获益。对于T1cN0M0期三阴性乳腺癌患者，低强度化疗方案与高强度蒽环类和紫杉类联合化疗相比，生存结局都较好。

Cancer. 2020 Aug 15;126 Suppl 16:3837-3846.

Adjuvant chemotherapy for small, lymph node-negative, triple-negative breast cancer: A single-center study and a meta-analysis of the published literature.

An X, Lei X, Huang R, Luo R, Li H, Xu F, Yuan Z, Wang S, de Nonneville A, Goncalves A, Houvenaeghel G, Li J, Xue C, Shi Y.

Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; The Second Affiliated Hospital of Kunming Medical University, Kunming, China; Aix-Marseille University, Institut Paoli-Calmettes, Marseille, France.

BACKGROUND: Current guidelines recommend adjuvant chemotherapy for patients with small, lymph node-negative, triple-negative breast cancer (TNBC) measuring >5 mm (T1b disease), but clinical evidence to support this recommendation is lacking. Thus, the current study aimed to evaluate the survival benefit of adjuvant chemotherapy in patients with T1N0M0 (measuring ≤2 cm) TNBC with different tumor sizes.

METHODS: The authors retrospectively evaluated consecutive patients with pT1N0M0 TNBC who were diagnosed between 2000 and 2016 at Sun Yat-Sen University Cancer Center. For the meta-analysis, electronic medical databases were searched for all relevant studies regarding the effect of adjuvant chemotherapy on the target population.

RESULTS: Of the 351 enrolled patients, 309 (88%) received adjuvant chemotherapy and 42 patients (12%) did not. The distribution by T classification was T1a in 19 patients (5.4%), T1b in 67 patients (19.1%), and T1c in 265 patients (75.5%). Adjuvant chemotherapy significantly improved recurrence-free survival (RFS) in the patients with T1c disease, but not those with T1b and T1a disease. Meanwhile, there was no difference in RFS noted according to the chemotherapy regimen among patients with T1c disease. Seven eligible studies comprising 1525 patients with T1N0M0 (941 with T1a/bN0M0) were included in the meta-analysis. The meta-analysis demonstrated that adjuvant chemotherapy significantly reduced the rate of disease recurrence for patients with T1a/b disease as a group, but the population driving that was only patients with T1b disease, not those with T1a disease.

CONCLUSIONS: Although the retrospective analysis demonstrated a survival benefit of adjuvant chemotherapy only for patients with T1cN0 TNBC, the meta-analysis showed it also is beneficial for individuals with T1bN0 TNBC. For patients with T1cN0M0 TNBC, less intensive chemotherapy regimens achieve an excellent survival outcome similar to that of intensive anthracycline and taxane combination chemotherapy.

KEYWORDS: adjuvant chemotherapy; lymph node-negative; meta-analysis; single-center study; small; triple-negative breast cancer

PMID: 32710666

DOI: 10.1002/cncr.32878