title: Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study.
abstract: BACKGROUND
  Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision.
  
  
  METHODS
  In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading.
  
  
  RESULTS
  There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46-1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45-1.88).
  
  
  CONCLUSIONS
  The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings-that are in line with several publications-should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Diessner
authors.affiliation: Faculty of Mathematics and Computer Science, University of Bremen Bremen, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wischnewsky
authors.affiliation: Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), University of Mainz, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Häusler
authors.affiliation: Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kreienberg
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Stein
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Stüber
authors.affiliation: Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwentner
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Catharina
authors.initials: C
authors.lastname: Bartmann
authors.affiliation: Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate