Daily Practice Management of pT1a-b pN0 Breast Carcinoma: A Prospective French ODISSEE Cohort Study

被引:2
|
作者
Dalenc, Florence [1 ,2 ]
Penault-Llorca, Frederique [3 ]
Cohen, Monique [4 ]
Houvenaeghel, Gilles [5 ]
Piat, Jean-Marc [6 ]
Liegeois, Philippe [6 ]
Puyuelo, Laurent [7 ]
Suchaud, Jean-Philippe [8 ]
Zouai, Mohammed [9 ]
Lacroix-Triki, Magali [1 ,2 ]
Radosevic-Robin, Nina [3 ]
Benkanoun, Chahinez [10 ]
Attar-Rabia, Hanane [10 ]
Chauvet, Marie-Pierre [11 ]
Gligorov, Joseph [12 ,13 ]
Belkacemi, Yazid [14 ,15 ,16 ]
机构
[1] Inst Univ Canc Toulouse UICT Oncopole, Claudius Regaud Inst, Dept Med Oncol, Toulouse, France
[2] INSERM, Canc Res Ctr, Team Cholesterol Metab & Therapeut Innovat, UMR 1037, Toulouse, France
[3] Jean Perrin Inst, Dept Pathol, Clermont Ferrand, France
[4] Private Inst, Dept Surg, Aubagne, France
[5] Paoli Calmettes Inst, Dept Surg, Marseille, France
[6] Breast Inst Orangerie, Strasbourg, France
[7] Union Clin, Dept Breast & Gynecol Surg, St Jean, France
[8] Roanne Hosp, Dept Radiotherapy, Roanne, France
[9] Marie Curie Inst, Dept Radiotherapy, Valence, France
[10] Roche, Meylan, France
[11] Oscar Lambret Anti Canc Ctr UNICANCER, Dept Breast Surg, Lille, France
[12] Tenon Hosp, AP HP, Dept Med Oncol, Paris, France
[13] Univ Paris 06, Paris, France
[14] AP HP, Dept Radiat Oncol, Creteil, France
[15] INSERM, Henri Mondor Breast Ctr, U955 E07, Creteil, France
[16] Univ Paris Est Creteil, Creteil, France
关键词
Adjuvant treatment; Breast cancer subtypes; Conservative surgery; Endocrine therapy; Radiotherapy; CLINICAL-PRACTICE; PRIMARY THERAPY; CANCER PATIENTS; RECURRENCE; PROGNOSIS; MORTALITY; RISK; OVEREXPRESSION; TRASTUZUMAB; GUIDELINES;
D O I
10.1016/j.clbc.2016.08.007
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The subgroup of breast cancer tumors 510 mm requiring adjuvant systemic therapy is currently not well defined. A prospective cohort study was conducted in patients with unifocal, invasive pT1a-b pN0 non-metastatic breast cancer to describe the daily adjuvant management and outcome after surgery. In this study, most patients had conservative surgery followed by radiotherapy and hormone therapy; however the benefit of adjuvant chemotherapy with or without trastuzumab remains controversial. Background: Most breast cancer (BC) tumors <= 10 mm have an excellent prognosis. The subgroups with a higher risk for distant recurrence requiring adjuvant systemic therapy are not precisely defined in current international guidelines. Patients and Methods: The OBSERVATOIRE DES PETITS CANCERS DU SEIN HER2 +/- (ODISSEE) study was a prospective, multicenter, cohort study that aimed to describe the daily adjuvant management and outcome of 616 patients with unifocal, invasive pT1a-b pN0 nonmetastatic BC who underwent surgery. Results: At the time of diagnosis, the median age of patients was 61 years. Tumor was detected on imaging or during a screening program in 397 patients (64.6%). Most patients (96%) underwent conservative surgery with sentinel node biopsy (89%), completed with axillary lymph node dissection in 15%. At inclusion, 82% of tumors were pT1b, 73% were pN0 (i-), 53% were Scarff Bloom Richardson Grade I, 91 % were estrogen receptor (ER)-positive, 5% overexpressed/amplified HER2, and 5% were triple negative (TNBC). Adjuvant treatments were radiotherapy (95%), hormone therapy (82%), chemotherapy (7%), and trastuzumab (3.5%). In patients with TNBC and HER2-positive BC, chemotherapy and trastuzumab (if needed) were administered in 45% and 68%, respectively. After 5 years of follow-up, 7 patients had contralateral BC, 7 had locoregional recurrence, and 1 had distant metastasis. At 5 years, overall survival, disease-free survival, and recurrence-free survival were: 98.4% (96.9%-99.1%), 94.7% (92.4%-96.3%), and 97.1 % (95.2%-98.2%), respectively. Conclusion: This prospective cohort study showed that in France, the routine practice in pT1a-b pN0 breast cancers follows international standard guidelines for practice including conservative surgery followed by radiotherapy and endocrine therapy for ER -positive patients. Adjuvant chemotherapy with or without trastuzumab was used but their benefit in breast cancer of <= 10 mm remains controversial. (C)2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:107 / 116
页数:10
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