Ann Surg Treat Res.  2022 Dec;103(6):313-322. 10.4174/astr.2022.103.6.313.

Omission of chemotherapy for hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer: patterns of treatment and outcomes from the Korean Breast Cancer Society Registry

• Kangleon-Tan HL
• Sim J
• You JY
• Lee ES
• Lee H
• Yang SM
• Seong MK
• Park EH
• Nam SJ
• Park MH
• Lee S
• Park WC
• Kangleon Jr RG
• Dy CB
• Bae SY
• Jung SP
• Korean Breast Cancer Society

• KMID: 2536907
• DOI: http://doi.org/10.4174/astr.2022.103.6.313

Abstract

Purpose
Although adjuvant chemotherapy (CTx) is still recommended for high-risk patients with hormone receptorpositive and human epidermal receptor (HER)-2-negative breast cancer, recent studies found that selected patients with low disease burden may be spared from CTx and receive hormonal treatment (HT) alone. This study aims to evaluate the trends of treatment (CTx + HT vs. HT alone) in Korea and to assess the impact on overall survival (OS) according to treatment pattern.
Methods
The Korean Breast Cancer Society Registry was queried (2000 to 2018) for women with pT1-2N0-1 hormone receptor-positive and HER2-negative disease who underwent surgery and adjuvant systemic treatment (CTx and HT). Clinicopathologic factors, change in pattern of treatment over time, and OS for each treatment option were analyzed.
Results
A total of 40,938 women were included in the study; 20,880 (51.0%) received CTx + HT, while 20,058 (49.0%) received HT only. In recent years, there has been a steady increase in the use of HT alone, from 21.0% (2000) to 64.6% (2018). In Cox regression analysis, age, type of breast and axillary operations, T and N stages, body mass index, histologic grade,and presence of lymphovascular invasion were prognostic indicators for OS. There was no significant difference between CTx + HT and HT alone in terms of OS (P = 0.126).
Conclusion
Over the years, there has been a shift from CTx + HT to HT alone without a significant difference in OS. Therefore, HT alone could be a safe treatment option in selected patients, even those with T2N1 disease.

Keyword

Breast neoplasms; Drug therapy; Estrogen receptor; Hormone antagonists; Prognosis

Figure

• 

  Fig. 1 Study flow diagram. HER2, human epidermal receptor-2; KBCSR, Korea Breast Cancer Society Registry; T, primary tumor stage; Tis, T stage in situ; Tx, T stage not determined; N, regional lymph node stage; Nx, N stage not determined; M, distant metastasis stage; Mx, M stage not determined; CTx, chemotherapy; BCS, breast-conserving surgery.

• 

  Fig. 2 Trends of use of chemotherapy (CTx) with hormonal therapy (HT) vs. HT alone with the time by age groups. (A) In the whole cohort. (B-E) In women aged ≤40 years (B), 41–50 years (C), 51–64 years (D), and ≥65 years (E).

• 

  Fig. 3 Trends of use of chemotherapy (CTx) with hormonal therapy (HT) vs. HT alone with the time by the tumor size and nodal status. (A) In T1N0 group. (B) In T2N0 group. (C) In T1N1 group. (D) In T2N1 group.

• 

  Fig. 4 Overall survival graphs by multivariate analysis using Cox regression analysis. (A) By age (P < 0.05). (B) By body mass index (P < 0.05). (C) By breast operation methods (P < 0.05). (D) By axillary operation method (P < 0.05). (E) By T stage (P < 0.05). (F) By N stage (P < 0.05). (G) By histologic grade (P < 0.05). (H) By presence of Lymphovascular invasion (P < 0.05). (I) By treatment methods (P = 0.130).

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