title: Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study.
abstract: OBJECTIVE
  Treatment decisions for patients with T1a,bN0M0 breast cancer are challenging. We studied the time trends in use of adjuvant chemotherapy and survival outcomes among these patients.
  
  
  METHODS
  This was a prospective cohort study within the National Comprehensive Cancer Network Database that included 4,113 women with T1a,bN0M0 breast cancer treated between 2000 and 2009. Tumors were grouped by size (T1a, T1b), biologic subtype defined by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, and receipt of chemotherapy with or without trastuzumab.
  
  
  RESULTS
  Median follow-up time was 5.5 years. Eight percent of patients with HR-positive/HER2-negative tumors were treated with chemotherapy. Fifty-two percent of those with HER2-positive or HR-negative/HER2-negative breast cancers received chemotherapy, with an increase over the last decade. Survival outcomes diverged by subtype and size, but the 5-year distant relapse-free survival (DRFS) did not exceed 10% in any subgroup. The 5-year DRFS for patients with T1a tumors untreated with chemotherapy ranged from 93% to 98% (n = 49 to 972), and for patients with T1b tumors, it ranged from 90% to 96% (n = 17 to 2,005). Patients with HR-positive/HER2-negative disease had the best DRFS estimates, and patients with HR-negative/HER2-negative tumors had the lowest. In this observational, nonrandomized cohort study, the 5-year DRFS for treated patients with T1a tumors was 100% for all subgroups (n = 12 to 33), and for patients with T1b tumors, it ranged from 94% to 96% (n = 88 to 241).
  
  
  CONCLUSIONS
  Women with T1a,b tumors have an excellent prognosis without chemotherapy. Size and tumor subtype may identify patients in whom the rate of recurrence justifies consideration of chemotherapy. These patients represent an optimal group for evaluating less toxic adjuvant regimens to maintain efficacy while minimizing short- and long-term risks.
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ines
authors.initials: I
authors.lastname: Vaz-Luis
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Ottesen
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hughes
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rizvan
authors.initials: R
authors.lastname: Mamet
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Gonzalez-Angulo
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Beverly
authors.initials: B
authors.lastname: Moy
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Hope S
authors.initials: HS
authors.lastname: Rugo
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Theriault
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.affiliation: Ines Vaz-Luis, Melissa E. Hughes, Harold J. Burstein, Jane C. Weeks, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital, Boston, MA; Ines Vaz-Luis, Instituto de Medicina Molecular, Lisbon, Portugal; Rebecca A. Ottesen and Rizvan Mamet, City of Hope, Duarte; Hope S. Rugo, University of California, San Francisco, San Francisco, CA; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Ana M. Gonzalez-Angulo and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX. nlin@partners.org.
authors.forename: Nancy U
authors.initials: NU
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D000068878:Trastuzumab; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D000068878:Trastuzumab; C508053:ERBB2 protein, human