Adjuvant Chemotherapy for Low-Clinical-Risk Breast Cancer Defined by Modified Version of Adjuvant! Online: A Propensity Score Matched SEER Analysis

Jiefeng Huang; Zhiyong Wu; Zechun Zhang; Jie Li; Yunhai Li; Guosheng Ren

doi:10.1159/000506697

Adjuvant Chemotherapy for Low-Clinical-Risk Breast Cancer Defined by Modified Version of Adjuvant! Online: A Propensity Score Matched SEER Analysis

Breast Care (Basel). 2021 Apr;16(2):156-162. doi: 10.1159/000506697. Epub 2020 May 27.

Authors

Jiefeng Huang^{1

2}, Zhiyong Wu³, Zechun Zhang³, Jie Li^{1

2}, Yunhai Li^{1

2}, Guosheng Ren^{1

2}

Affiliations

¹ Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³ Diagnosis and Treatment Center of Breast Diseases, Shantou Affiliated Hospital of Sun Yat-Sen University, Shantou, China.

Abstract

Background: The purpose of this research was to investigate whether the modified version of Adjuvant! Online was able to omit chemotherapy (CT) for patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, and axillary node-negative breast cancer, who are defined as low clinical risk.

Methods: From 2010 to 2014, HR-positive, HER2-negative, and node-negative breast cancer patients aged 50 years and older were retrieved from the Surveillance, Epidemiology, and End Results (SEER) 18 database. The propensity score matching method was applied between the no-CT and CT groups. Overall survival (OS) was evaluated using Kaplan-Meier analysis and compared across groups using a log-rank test.

Results: A total of 48,857 patients were enrolled. After propensity score matching, the numbers of patients in the no-CT and CT groups were both 3,102. The median follow-up period was 37 months. The 5-year OS rates in the no-CT and CT groups were 92 and 91%, respectively (p = 0.066). In the subgroup with a tumor score (tumor size added to tumor grade) of 2-3, OS was significantly higher in the no-CT group than in the CT group (93 vs. 90%, p < 0.001). In the subgroup with a tumor score of 4, OS was not different between these 2 groups (92 vs. 93%, p = 0.47).

Conclusion: This retrospective study provides evidence that CT may not be beneficial to patients 50 years of age or older with HR-positive, HER2-negative, axillary node-negative breast cancer and additionally defined as low clinical risk by a modified version of Adjuvant! Online.

Keywords: Adjuvant chemotherapy; Adjuvant! Online; Breast cancer; Risk factors; SEER database.