Evaluating the efficacy of current clinical practice of adjuvant chemotherapy in postmenopausal women with early-stage, estrogen or progesterone receptor–positive, one-to-three positive axillary lymph node, breast cancer

[摘要] Purpose We evaluated the benefit of the current clinical practice of adjuvant chemotherapy for postmenopausal women with early-stage, estrogen- or progesteronereceptor-positive (er/pr+), one-to-three positive axillary lymph node (1–3 ln+), breast cancer (esbc). Methods Using the Manitoba Cancer Registry, we identified all postmenopausal women diagnosed with er/pr+ 1–3 ln+ esbc during the periods 1995–1997, 2000–2002, and 2003–2005 (n = 156, 161, and 171 respectively). Treatment data were obtained from the Manitoba Cancer Registry and by linkage with Manitoba administrative databases. Seven-year survival data were available for the 1995–1997 and 2000–2002 populations. Using Cox regression, we assessed the independent effect of the clinical practice of adjuvant chemotherapy on disease-free (dfs) and overall survival (os). Results Clinical breast cancer treatments did not differ significantly between the 2000–2002 and 2003–2005 populations. Adjuvant chemotherapy was administered in 103 patients in the 2000–2002 population (64%) and in 44 patients in the 1995–1997 population [28.2%; mean difference: 36%; 95% confidence interval (ci): 31% to 40%; p < 0.0001]. Compared with 1995–1997, 2000–2002 was not significantly associated with an incremental dfs benefit for patients over a period of 7 years (2000–2002 vs. 1995–1997; adjusted hazard ratio: 0.98; 95% ci: 0.64 to 1.4). Conclusions The treatment standard of adjuvant chemotherapy in addition to endocrine therapy may not be effective for all women with er/pr+ 1–3 ln+ esbc. There could be a subgroup of those women who do not benefit from adjuvant chemotherapy as expected and who are therefore being overtreated. Further studies with a larger sample size are warranted to confirm our results.

[学科分类] 肿瘤学