- Paper Report
- Open Access
Prognosis and treatment of small breast carcinomas
- Frances O'Malley1
© Biomed Central Ltd 2001
- Received: 8 March 2001
- Accepted: 20 August 2001
- Published: 1 December 2001
- Chemotherapy, lymph node negative, prognosis, tumor size
Although many clinical trials have assessed the efficacy of adjuvant therapy in women with lymph node negative (LNN) disease, few trials have included enough women with tumors 1 cm in diameter or less to draw definite conclusions about the benefit of this therapy in this cohort of patients.
The aim of this study was to determine if pooling data from several large NSABP trials from women with small tumors would provide information on determining prognosis in women with tumors =1 cm, as well as to provide guidance with respect to the use of adjuvant therapy in this population of women.
There were over 3000 patients with ER-negative tumors enrolled in the B-13, B-19 and B-06 trials; however, only 235 (7.8%) of these women had tumors =1 cm and LNN disease. In this small cohort, the 8-year recurrence-free survival for patients who were treated by surgery was 81% versus 91% for those patients treated with chemotherapy (P= 0.06). While the aim of this study was to focus on patients with tumors =1 cm, the majority of patients in both groups had tumors reported as exactly 1 cm (which is likely to be a 'rounding off' effect), while only 36 patients had tumors =5 mm (T1a). Almost 4000 patients with ER-positive, LNN disease were enrolled in the NSABP B-14, B-20 and B-06 trials. Of these, 1024 patients were included in the outcome analysis. However, approximately 60% of tumors in the control and chemotherapy groups were exactly 1 cm (which is again likely to be a 'rounding off' effect), while only 6% in both the control (17 patients) and chemotherapy plus tamoxifen (13 patients) groups had tumors =5 mm. Clearly, the patients with T1a tumors represent a minute subset of all the patients enrolled in the clinical trials.
Women with tumors =1 cm and LNN disease were selected from several NSABP randomized control trials, investigating the efficacy of various treatments: various chemotherapeutic regimens (B-13, B-19); tamoxifen, either alone (B-14) or in combination with other chemotherapy (B-20); and lumpectomy versus mastectomy (B-06). Kaplan-Meier curves were used to describe distributions of time to recurrence-free survival and event-free survival. Although the studies had different lengths of follow-up, all had an average follow-up of at least 8 years; thus only follow-up information up to 8 years was included in the analysis. Analysis for women with estrogen receptor (ER)-positive tumors was reported separately from those with ER-negative tumors.
Lippman ME, Hayes DF: Adjuvant therapy for all patients with breast cancer.
J Natl Cancer Inst 2001, 93:80-82 (PubMed abstract).