Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study

• Published in: PloS one Vol. 14; no. 7; p. e0218434
• Main Authors: Herr, Daniel, Wischnewsky, Manfred, Joukhadar, Ralf, Chow, Olivia, Janni, Wolfgang, Leinert, Elena, Fink, Visnja, Stüber, Tanja, Curtaz, Carolin, Kreienberg, Rolf, Blettner, Maria, Wollschläger, Daniel, Wöckel, Achim
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08-07-2019; Public Library of Science (PLoS)
• Subjects: Adjuvant chemotherapy; Aged; Biology and Life Sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Cancer patients; Cancer research; Cancer therapies; Cancer treatment; Care and treatment; Cell growth; Chemotherapy; Chemotherapy, Adjuvant; Disease-Free Survival; Endocrine therapy; Epidemiology; Evidence-based medicine; Female; Gene expression; Gynecology; Humans; Informatics; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Medical prognosis; Medical research; Medicine and Health Sciences; Metastasis; Middle Aged; Neuroendocrine tumors; Nodes; Obstetrics; Operating systems (Software); Patient outcomes; Population studies; Prognosis; Recurrence (Disease); Retrospective Studies; Survival; Survival analysis; Survival Rate; Tumors; Germany
• DOI: 10.1371/journal.pone.0218434
• EISSN: 1932-6203

In this study based on the BRENDA data, we investigated the impact of endocrine ± chemotherapy for luminal A, nodal positive breast cancer on recurrence free (RFS) and overall survival (OS). In addition, we analysed if tumor size of luminal A breast cancer influences survival in patients with the same number of positive lymph nodes.
In this retrospective multi-centre cohort study data of 1376 nodal-positive patients with primary diagnosis of luminal A breast cancer during 2001-2008 were analysed. The results were stratified by therapy and adjusted by age, tumor size and number of affected lymph nodes.
In our study population, patients had a good to excellent prognosis (5-year RFS: 91% and tumorspecific 5-year OS 96.5%). There was no significant difference in RFS stratified by patients with only endocrine therapy and with endocrine plus chemo-therapy. Patients with 1-3 affected lymph nodes had no significant differences in OS treated only with endocrine therapy or with endocrine plus chemotherapy, independent of tumor size. Patients with large tumors and more than 3 affected lymph nodes had a significant worse survival as compared to the small tumors. However, despite the worse prognosis of those, adjuvant chemotherapy failed in order to improve RFS.
According to our data, nodal positive patients with luminal A breast cancer have, if any, a limited benefit of adjuvant chemotherapy. Tumor size and nodal status seem to be of prognostic value in terms of survival, however both tumor size as well as nodal status were not predictive for a benefit of adjuvant chemotherapy.