title: Assessing the impact of CMF-like/Anthracycline-based/Anthracycline-Taxane-based/dose-dense chemotherapy in dependency of positive axillary lymph nodes/hormone receptor-status/grading/T-stage on survival - A retrospective multi-centre cohort study of 3677 patients receiving adjuvant chemotherapy.
abstract: OBJECTIVE
  Adjuvant chemotherapy has changed dramatically in the last decades. Anthracycline-/Taxane-based and dose-dense chemotherapy regimens improved survival in node positive breast cancer. This study tries to answer the following questions:
  
  
  METHODS
  This is a German multi-centre (17 participating hospitals all certified as breast cancer centres) retrospective cohort study. We included patients that received CMF-like (CMF) (n=1308), Anthracycline-based (A) (1046), Anthracycline-Taxane-based (AT) (1110) and dose-dense chemotherapy (DD) (213) into this analysis.
  
  
  RESULTS
  In case of N0 and 1-3 pos LN we did not observe statistically significant differences in overall (OS) and disease-free survival (DFS) between CMF/A/AT and (for 1-3 pos LN) DD. In the group of 4-10 pos LN we observe an improvement by the use of AT-based chemotherapy, which cannot further be improved by DD chemotherapy. However in the highest risk group, defined as ⩾11 pos LN, we observed a statistically significant improvement in survival by the use of DD chemotherapy. Also a statistically slightly non-significant trend towards improvement of survival parameters by the use of DD compared to AT chemotherapy could be observed. Only for G3 subtypes we could observe a survival benefit for DD. These results remain consistent after exclusion of non-guideline adherent patients (surgery, radiotherapy and endocrine therapy) in order to reduce the bias of guideline violations in other adjuvant treatment modalities.
  
  
  CONCLUSIONS
  DD chemotherapy is associated with improved survival parameters in patients with ⩾11 positive LN.
authors.affiliation: Department of Gynaecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany. Electronic address: lukas.schwentner@yahoo.de.
authors.forename: L
authors.initials: L
authors.lastname: Schwentner
authors.affiliation: Department of Gynaecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wöckel
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: König
authors.affiliation: Department of Gynaecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Janni
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Department of Gynaecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kreienberg
authors.affiliation: Department of economics, Institute for medical biostistics, epidemiology and informatics, University medical centre, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, Mainz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Van Ewijk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy / Q000401:mortality; D017410:Practice Guidelines as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; C080625:taxane; C508053:ERBB2 protein, human
keywords: Adjuvant chemotherapy; Axillary lymph node metastasis; Breast cancer; Clinical cohort study; Dose-dense chemotherapy; Grading; Survival