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Gori S, Clavarezza M, Siena S, Foglietta J, Tarenzi E, Giordano M, Molino A, Graiff C, Fusco V, Alabiso O, Baldini E, Gamucci T, Altavilla G, Dondi D, Venturini M. Adjuvant chemotherapy of pT1a and pT1b breast carcinoma: results from the NEMESI study. BMC Cancer 2012; 12:158. [PMID: 22545982 PMCID: PMC3404902 DOI: 10.1186/1471-2407-12-158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 04/30/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The prognosis of pT1a-pT1b breast cancer (BC) used to be considered very good, with a 10-y RFS of 90%. However, some retrospective studies reported a 10-y RFS of 81%-86% and suggested benefit from adjuvant systemic therapy. METHODS To evaluate the variables that determined the choice of adjuvant chemotherapy and the type of chemotherapy delivered in pT1a-pT1b BC, we analysed the small tumours enrolled in the NEMESI study. RESULTS Out of 1,894 patients with pathological stage I-II BC enrolled in NEMESI, 402 (21.2%) were pT1a-pT1b. Adjuvant chemotherapy was delivered in 127/402 (31.59%). Younger age, grading G3, high proliferative index, ER-negative and HER2-positive status were significantly associated with the decision to administer adjuvant chemotherapy. An anthracycline without taxane regimen was administered in 59.1% of patients, anthracycline with taxane in 24.4%, a CMF-like regimen in 14.2% and taxane in 2.4%. Adjuvant chemotherapy was administered in 88.4% triple-negative and 73.46% HER2-positive pT1a-pT1b BC. Adjuvant trastuzumab was delivered in 30/49 HER2-positive BC (61.2%). CONCLUSIONS Adjuvant chemotherapy was delivered in 31.59% T1a-pT1b BC treated at 63 Italian oncological centres from January 2008 to June 2008. The choice to deliver chemotherapy was based on biological prognostic factors. Anthracycline-based chemotherapy was administered in 83.5% patients.
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Affiliation(s)
- Stefania Gori
- Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
- Division of Medical Oncology, Ospedale S. Maria della Misericordia, Azienda Ospedaliera Perugia, via Dottori 1, Perugia, 06122, Italy
| | | | - Salvatore Siena
- Struttura Complessa di Oncologia Falck, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Jennifer Foglietta
- Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Emiliana Tarenzi
- Struttura Complessa di Oncologia Falck, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | | | - Annamaria Molino
- U.O.C. di Oncologia dell’Ospedale Civile Maggiore, Azienda Ospedaliera-Universitaria di Verona, Verona, Italy
| | | | - Vittorio Fusco
- Oncologia, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | - Oscar Alabiso
- SC Oncologia, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy
| | | | - Teresa Gamucci
- UO Oncologia Medica, Ospedale S.S. Trinità, Sora (FR), Sassari, Italy
| | | | - Davide Dondi
- Medical & Scientific Department, Sanofi-Aventis, Milan, Italy
| | - Marco Venturini
- Oncologia, Ospedale Sacro Cuore-Don Calabria, Negrar, (VR), Italy
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Petrelli F, Barni S. Role of HER2-neu as a prognostic factor for survival and relapse in pT1a-bN0M0 breast cancer: a systematic review of the literature with a pooled-analysis. Med Oncol 2012; 29:2586-93. [PMID: 22415399 DOI: 10.1007/s12032-012-0201-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/23/2012] [Indexed: 01/03/2023]
Abstract
High levels of human epidermal growth receptor 2 (HER2) expression are associated with recurrence and death in breast cancer (BC) patients. We have performed a systematic review and meta-analysis in order to evaluate the prognosis for HER2+ pT1a-bN0M0 BC patients. A search of PubMed and Embase was performed. Studies were included if they reported hazard ratios (HRs) with a 95% confidence interval (CI) for multivariate analyses of relapse or survival in pT1a-bN0M0, HER2+ BC patients treated with surgery and chemotherapy and/or endocrine therapy, but not with trastuzumab. A total of 764 patients from seven studies were included in the meta-analysis. In the pooled analysis, HER2 had a detrimental effect on relapse-free (HR 4.68, 95% CI 3.05-7.18; p<0.00001) and distant relapse-free survival, with a HR of 5.6 (95% CI 2.65-11.85; p<0.00001). HER2+ status was also linked to increased risk of death (HR 3.4, 95% CI 0.86-13.41; p=0.08) and worst BC-specific survival (HR 2.61, 95% CI 1.51-4.51; p=0.0006), but these data were presented in few studies. HER2+ pT1a-bN0M0 BC is associated with a dismal prognosis. In these patients, HER2 has to be taken into account when deciding on adjuvant therapy, and trastuzumab should be considered.
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Affiliation(s)
- F Petrelli
- Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio-Caravaggio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
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