Triple-negative breast cancer outcomes: Does AJCC 8th staging improve chemotherapy decision-making

The necessity of adjuvant chemotherapy in young patients with T1N0M0 breast cancer: a population-based study

Chemotherapy clearly adversely affects fertility in women of childbearing age. But it is not yet clear whether chemotherapy at the expense of fertility can benefit younger patients with early-stage breast cancer. We conducted a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results database and the Shanghai Jiao Tong University Breast Cancer Data Base spanning from 2010 to 2020 to investigate early-stage breast malignant carcinoma in patients aged between 20 and 39 years. To address covariate imbalance, propensity score matching (PSM) was employed with a ratio of 1:1 and caliper set at 0.02 standard deviation of propensity score. Univariate and multivariate analyses were performed to evaluate the impact of chemotherapy on both breast cancer-specific survival (BCSS) and overall survival (OS). We identified a total of 6265 patients with complete information about breast cancer. Among them, 3855 patients received chemotherapy. Following successful PSM, we obtained a matched cohort comprising 3038 patients where the characteristics between the two groups were balanced except for race. Kaplan-Meier survival analysis revealed no significant differences in BCSS (P = 0.183) and OS (P = 0.295) between the chemotherapy group and no-chemotherapy group. Similarly, in matched dataset. multivariate COX analysis revealed that chemotherapy did not significantly reduce the risk of BCSS (HR 1.332; 95% CI [0.865-2.051], P = 0.193) and OS (HR 1.225; 95% CI [0.818-1.833], P = 0.324). The chemotherapy group did not demonstrate a superior benefit in any of the subgroups when stratified analyses were conducted based on molecular subtype, tumor size, age, and ethnicity. Chemotherapy fails to significantly improve prognostic outcomes in young patients diagnosed with early-stage breast cancer. With the help of genetic testing, these patients can expect further step-down therapy in the future.

Stage-Specific Survival in Breast Cancer in Chinese and White Women: Comparative Data Analysis

BACKGROUND

Stage-specific survival, according to the eighth edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) on breast cancer (BC), between Chinese and White American women remains unclear.

OBJECTIVE

This study aimed to assess stage-specific survival in BC between Chinese and White American women according to the eighth AJCC PPS.

METHODS

We included Chinese and White American women with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. A chi-square test, the Kaplan-Meier method, a receiver operating characteristic (ROC) curve, and multivariate Cox proportional hazards models were used for data analysis.

RESULTS

We included 376,818 individuals in this study: 369,522 White American and 7296 Chinese. Of them, 149,452 (39.7%) migrated from the seventh AJCC anatomic staging (AS) to the eighth AJCC PPS, 22,516 (6.0%) were upstaged, and 126,936 (33.7%) were downstaged. With a median follow-up duration of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The seventh AJCC AS (P<.001) and the eighth AJCC PPS (P<.001) could significantly predict the survival outcomes of BC, and multivariate analysis revealed that both staging systems were significant prognostic indicators of CSS. The ROC curve revealed that the PPS had a better discriminating ability than the AS (area under the curve [AUC] 0.769 vs 0.753, P<.001). Similar trends were observed after stratification by the 2 ethnic groups. The eighth AJCC PPS had better discriminating ability than the seventh AJCC AS among both White American (AUC 0.769 vs 0.753, P<.001) and Chinese patients (AUC 0.790 vs 0.776, P<.001). In the seventh AJCC AS, Chinese women had better CSS in stage IA (P=.02), stage IIA (P=.005), and stage IIIB (P=.04) disease than White American women, but no significant CSS was observed in stage IB, IIB, IIIA, and IIIC disease between the 2 ethnic groups. Regarding the eighth AJCC PPS, Chinese women had better CSS in stage IA (P=.002) and IIIA (P=.046) disease than White American women, and CSS was similar in Chinese and White American women in other substages.

CONCLUSIONS

The eighth AJCC PPS has a similar discriminative ability between White American and Chinese individuals with BC compared with the seventh AJCC AS. Therefore, the eighth AJCC PPS is also applicable to Chinese individuals with BC.

Are we overtreating stage I triple-negative breast cancer in Ontario? A population-based retrospective epidemiological analysis using the ICES database

Triple-negative breast cancer (TNBC) is associated with inferior outcomes. The use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy was demonstrated to be correlated with tumor size. Different guidelines exist regarding chemotherapy in early-stage TNBC. This study uses ICES database to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC in Ontario stratified by tumor size. Records of TNBC patients diagnosed in 2012 to 2014 were collected from ICES database. Stage I patients were analyzed by tumor size: T1a (≤ 0.5 cm), T1b (> 0.5 cm and ≤ 1.0 cm), and T1c (> 1.0 cm and ≤ 2.0 cm). Kaplan-Meier curves, log-rank test statistic, and Cox's proportional hazard regression were used to compare differences in overall survival (OS) between chemotherapy and no-chemotherapy groups. Of 610 patients, 183 had tumor sizes ≤ 1 cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumors > 1 cm to 2 cm, representing stage T1cN0M0. Patients with tumors ≤ 1 cm who received chemotherapy did not have a significant difference in OS compared to the no-chemotherapy group (p = 0.41, hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.021-2.5). However, patients with tumor sizes > 1 cm to 2 cm who received chemotherapy demonstrated significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16-0.86). Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy. For TNBC tumors ≤ 1 cm, avoidance of chemotherapy can be considered. Prospective research should further investigate the efficacy of chemotherapy in TNBC stages T1a-bN0M0.Trial Registration University of Windsor REB#16-119.

OUP accepted manuscript

Background

Methods

Results

Conclusion

Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand

Purpose

Breast cancer is a growing public health challenge in Thailand. Pathum Raksa project was launched in 2015, as a result of higher than expected rate of triple-negative breast cancers in Thai women. The purpose of this project was to identify the cause(s) and address the issue(s), hence improving the quality of breast cancer biomarker testing in Thailand.

Materials and Methods

Nineteen hospitals across the country, with 902 breast cancer patients were enrolled in this study during 2015–2020. The pre- and post-data from Pathum Raksa initiative was only available for Khon Kaen University (KKU) and Udonthani hospitals in Northeast Thailand. We developed a resource-stratified strategic plan that included designing a unique specimen container, forming multidisciplinary teams from the Surgery and Pathology Departments, and employing locally developed innovative technologies to optimize the entire process of breast cancer diagnostics and biomarker testing.

Results

The rate of triple-negative breast cancers in KKU and Udonthani decreased 52.8% (p = 0.02) and 28.9% (p = 0.48), respectively. The rate of ER+ breast cancers in both hospitals increased 5% post-Pathum Raksa implementation. The rate of HER2-neu+ (score 3+) also increased in both hospitals (particularly an increased 65% rate in KKU). Luminal A/B cancers were the most common subtype in both KKU and Udonthani hospitals.

Conclusion

Pathum Raksa project has significantly improved breast cancer biomarker testing in Thailand. As a result of this national innovation, false-negative rates of breast biomarkers have significantly decreased, resulting in improving prognosis, treatment, and survival of breast cancer women in Thailand.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/v37IVgjnRYE