腫瘤≤2厘米（T1）淋巴結陰性（N0）無遠處轉(zhuǎn)移（M0）的乳腺癌患者被認為預后良好，即使對于無復發(fā)生存和總生存通常較差的三陰性乳腺癌。雖然目前化療仍為三陰性乳腺癌的唯一輔助治療方法，但是術后輔助化療有益于T1N0M0三陰性乳腺癌患者的證據(jù)有限。

　　2018年12月5日，歐洲乳腺癌專科學會《乳腺》在線發(fā)表復旦大學附屬腫瘤醫(yī)院任毅行、金希、葉富貴、龔悅、江一舟、邵志敏等學者的研究報告，評估了T1N0M0三陰性乳腺癌患者輔助化療的作用和紫杉類的獲益。

　　該研究于2008年1月～2015年12月從復旦大學附屬腫瘤醫(yī)院入組連續(xù)354例新診斷為T1N0M0三陰性乳腺癌患者，通過單因素和多因素生存分析，對有、無紫杉類的輔助化療患者生存進行比較。

　　結果，隨訪時間中位45個月，其中化療患者占92.4%。有、無輔助化療患者的5年無復發(fā)生存率分別為94.5%、83.6%。根據(jù)多因素分析，輔助化療和未侵犯淋巴血管，與無復發(fā)生存顯著獲益相關。

　　根據(jù)亞組分析，有、無輔助化療相比：

• T1c患者無復發(fā)生存獲益顯著（風險比：0.24，95%置信區(qū)間：0.08～0.76，P=0.014）

• T1b患者無復發(fā)生存獲益相似（風險比：0.32，95%置信區(qū)間：0.03～3.18，P=0.330）

　　對于T1N0M0三陰性乳腺癌患者，蒽環(huán)類±紫杉類相比，無復發(fā)生存相似。

　　因此，該研究結果表明，T1c與T1b三陰性乳腺癌患者相比，輔助化療可以顯著改善無復發(fā)生存，對于T1b三陰性乳腺癌患者可以考慮免去輔助化療。對于T1N0M0三陰性乳腺癌患者，將紫杉類加入蒽環(huán)類輔助化療的無復發(fā)生存獲益不顯著，無紫杉類的蒽環(huán)類輔助化療方案可能足以實現(xiàn)T1N0M0三陰性乳腺癌患者無復發(fā)生存獲益。

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