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对于三阴性乳腺癌患者，术后辅助放化疗仍然是唯一推荐的治疗方法。不过，对于T1N0M0期（肿瘤≤2厘米、淋巴结阴性、未远处转移）三阴性乳腺癌患者，现有证据似乎不足以推荐术后辅助放化疗。 2020年11月19日，《美国医学会杂志》网络开放版在线发表浙江大学医学院附属第一医院、西安交通大学第二附属医院、哈佛大学医学院达纳法伯癌症研究院的研究报告，按乳腺癌分期和年龄分层，对T1N0M0期三阴性乳腺癌患者不同术后辅助治疗的生存结局进行了大数据分析。 该定群研究对美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）癌症登记数据库2010～2015年被诊断为T1N0M0期三阴性乳腺癌的术后患者进行回顾分析。数据分析于2019年3月27日～2020年8月10日进行。通过生存曲线、单因素和多因素比例风险回归模型，对年龄、婚姻、肿瘤分级、分期、手术、术后辅助治疗方法进行校正，比较不同治疗的总生存、乳腺癌相关生存。 结果，7739例患者符合条件，平均年龄59.5±12.4岁，全部为女性，中位随访45个月（95%置信区间：44～46个月），5年总生存率为91.7%（95%置信区间：90.9%～92.5%）。 年龄≥70岁与<70岁相比、T1a期与T1b～T1c期相比，三阴性乳腺癌患者术后辅助放化疗的比例较高。 虽然任何辅助治疗都可改善T1N0M0期三阴性乳腺癌的总生存，但是只有化疗才能显著改善乳腺癌相关生存，乳腺癌相关死亡风险低34%（校正风险比：0.657，95%置信区间：0.460～0.939，P=0.02）。 保乳术后辅助放疗与未放疗相比：
对于T1c期乳腺癌患者，术后辅助化疗与未化疗相比：
因此，该定群回顾研究结果表明，对于T1N0M0期三阴性乳腺癌患者，术后任何辅助治疗都可改善总生存、减少总死亡风险，而只有化疗才能显著改善乳腺癌相关生存、减少乳腺癌相关死亡风险，早期三阴性乳腺癌老年患者可对术后辅助放疗获益，故有必要开展进一步定群前瞻研究对中国患者进行验证，深入探讨不同年龄和乳腺癌分期患者的术后辅助治疗方法，并对指南进行更新。 JAMA Netw Open. 2020 Nov 19;3(11):e2021881. Evaluation of Adjuvant Treatments for T1 N0 M0 Triple-Negative Breast Cancer. Zhai Z, Zheng Y, Yao J, Liu Y, Ruan J, Deng Y, Zhou L, Zhao P, Yang S, Hu J, We B, Wu Y, Zhang D, Kang H, Dai Z. The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. This cohort study evaluates the association of different adjuvant therapies with survival outcomes in patients with triple-negative breast cancer. QUESTION: Should patients with T1 N0 M0 triple-negative breast cancer (TNBC) receive routine adjuvant chemotherapy and radiotherapy after surgery? FINDINGS: In this cohort study of 7739 postoperative patients diagnosed as having T1 N0 M0 TNBC from the Surveillance, Epidemiology, and End Results cancer registry program, receipt of adjuvant therapies was associated with an overall survival benefit. Adjuvant radiotherapy after breast-conserving surgery was associated with better overall and breast cancer-specific survival in patients aged 70 years and older but not in those younger than 70 years. MEANING: Administration of adjuvant therapies to patients with different ages and cancer stages should be discussed carefully, which necessitates guidance from updated guidelines. IMPORTANCE: Adjuvant chemotherapy remains the only recommended treatment for patients with triple-negative breast cancer (TNBC). However, the existing evidence is not enough to recommend adjuvant therapies to patients with T1 N0 M0 TNBC. OBJECTIVE: To evaluate the association of different adjuvant therapies with survival outcome in patients with T1 N0 M0 TNBC stratified by cancer stage and age. DESIGN, SETTING, AND PARTICIPANTS: Postoperative patients diagnosed as having T1 N0 M0 TNBC between 2010 and 2015 who were enrolled in the Surveillance, Epidemiology, and End Results cancer registry program were included in this population-based cohort study. Data analysis was performed from March 27, 2019, to August 10, 2020. EXPOSURES: Chemotherapy and radiotherapy. MAIN OUTCOMES AND MEASURES: Kaplan-Meier curve and univariate and multivariable Cox proportional hazards regression analyses were performed to compare overall survival (OS) and breast cancer-specific survival (BCSS) between the different treatments. RESULTS: A cohort of 7739 eligible patients (mean [SD] age, 59.5 [12.4] years; all female) were included in the present study. The 5-year OS of the total patients was 91.7% (95% CI, 90.9%-92.5%), and median follow-up was 45 months (95% CI, 44-46 months). Patients aged 70 years and older or with T1a TNBC were more likely to receive adjuvant radiotherapy than chemotherapy. Although any adjuvant therapy could improve OS in T1 N0 M0 TNBC, only chemotherapy was associated with significantly better breast cancer-specific survival (BCSS adjusted hazard ratio: 0.657; 95% CI, 0.460-0.939; P = .02). Adjuvant radiotherapy after breast-conserving surgery was associated with better OS and BCSS in patients aged 70 years and older but not in those younger than 70 years. For patients with T1c BC, chemotherapy after breast-conserving surgery or other surgery was associated with improved OS, whereas only chemotherapy after other surgery was associated with better BCSS. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that adjuvant therapies could improve OS in patients with T1 N0 M0 TNBC, whereas only chemotherapy was associated with better BCSS. Older patients with early-stage TNBC may benefit from adjuvant radiotherapy. Administration of adjuvant therapies to patients with different ages and cancer stages should be discussed carefully, which necessitates guidance from updated guidelines. PMID: 33211105 DOI: 10.1001/jamanetworkopen.2020.21881
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