title: Impact of Adjuvant Chemotherapy on Breast Cancer Survival: A Real-World Population.
abstract: BACKGROUND
  The impact of adjuvant chemotherapy on breast cancer prognosis has been demonstrated in randomized trials, but its impact is unknown in real-world populations. The aim of this study was to evaluate the effect of adjuvant chemotherapy on the survival of breast cancer patients in an unselected population.
  
  
  METHODS
  This prospective cohort study included 32,502 women treated at the Institut Curie between 1981 and 2008 for a first invasive breast cancer without metastasis. The patients were matched based on their propensity score to receive adjuvant chemotherapy.
  
  
  RESULTS
  The matching generated a subsample of 9,180 patients with an overlapping propensity score. In the group without chemotherapy, the overall survival (OS) rates at 5 and 10 years of follow-up were 87.6% (95% CI [86.7-88.6]) and 75.0% (95% CI [73.6-76.5]), respectively, versus 92.1% (95% CI [91.3-92.9]) and 81.9% (95% CI [80.6-83.2]), respectively, in the chemotherapy group. Distant disease-free survival (DDFS) was significantly improved in the five first years (absolute benefit of 3.5%). In a multivariate analysis, adjuvant chemotherapy was associated with better OS (HR = 0.75, 95% CI [0.69-0.83], p<0.0001) and DDFS (HR = 0.82, 95% CI [0.75-0.90], p<0.0001).
  
  
  CONCLUSIONS
  Adjuvant chemotherapy significantly improves OS and DDFS rates in an unselected population, in accordance with previous results reported by randomized trials.
authors.affiliation: Institut Curie, Paris, France; Equipe d'Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France.
authors.forename: Lea
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Denise
authors.initials: D
authors.lastname: Stevens
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Lerebours
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Reyal
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Robain
authors.affiliation: Institut Curie, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Asselain
authors.affiliation: Institut Curie, Paris, France; Equipe d'Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011446:Prospective Studies; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor