J Cancer 2021; 12(1):10-17. doi:10.7150/jca.52540

Research Paper

The role of chemotherapy in patients with T1bN0M0 triple-negative breast cancer: a real-world competing risk analysis

Tian Lan1,2✉, Yunyan Lu3, Hua Luo1, Ouou Yang1, Junling He1, Haibin Xu1, Zujian Hu1✉

1. Department of Breast Surgery, Guangxing Hospital Affiliated to Zhejiang Traditional Chinese Medicine University, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, People's Republic of China
2. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
3. Department of Cardiology, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, People's Republic of China
Tian Lan and Yunyan Lu contributed equally to this work.

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Citation:
Lan T, Lu Y, Luo H, Yang O, He J, Xu H, Hu Z. The role of chemotherapy in patients with T1bN0M0 triple-negative breast cancer: a real-world competing risk analysis. J Cancer 2021; 12(1):10-17. doi:10.7150/jca.52540. Available from https://www.jcancer.org/v12p0010.htm

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Abstract

The objective of the present study was to implement Kaplan-Meier analysis, competing risk analysis, and propensity score matching to evaluate whether the patients with T1bN0M0 triple-negative breast (TNBC) could benefit from adjuvant chemotherapy. A total of 1849 patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All eligible patients were divided into two cohorts, the chemotherapy (1155 patients) and the no-chemotherapy (694 patients) cohorts. Similar 5-year breast cancer-specific survival (BCSS) was observed in the chemotherapy and no-chemotherapy cohorts (96.1% vs. 96.0%, p=0.820). The results of the competing risk analysis showed a comparable 5-year breast cancer-specific death (BCSD) in both groups (chemotherapy 3.6% vs. no-chemotherapy 3.4%, p=0.778). Also, a higher 5-year other causes death (OCD) was observed in the no-chemotherapy cohort (0.7% vs. 5.4%, p<0.001). Multivariable competing risks regression models showed no association between chemotherapy and BCSS (HR, 1.21; 95%CI, 0.64-2.31; p=0.560). After 1:1 PSM, no significant difference was also observed for BCSD and OCD between two cohorts. The value of adjuvant chemotherapy in patients with T1bN0M0 TNBC is less than the present guidelines recommend, suggesting that de-escalated treatment could be a potentially beneficial strategy in appropriately selected patients.

Keywords: triple-negative breast cancer, chemotherapy, T1bN0M0 breast cancer, survival analysis