Ann Surg Treat Res.  2023 Jul;105(1):31-36. 10.4174/astr.2023.105.1.31.

Can chemotherapy be omitted for patients with N0 or N1 endocrine-sensitive breast cancer treated with gonadotropin-releasing hormone agonist and tamoxifen?

  • 1Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
  • 2Division of Fusion Radiology Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
  • 3Department of Surgery, Konkuk University Medical Center, Seoul, Korea


Whether administering chemotherapy followed by tamoxifen plus a gonadotropin-releasing hormone (GnRH) agonist to treat patients with lower-risk hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer provides a greater benefit than administering tamoxifen plus GnRH agonist alone remains unclear. This study aimed to compare the outcomes of propensity score-matched (PSM) patients who underwent these 2 types of treatment plans.
This retrospective study included patients treated at our institution between 2009 and 2019. Eligible patients had HR-positive, HER2-negative, invasive breast cancer who had undergone surgery. There were 579 patients with HR-positive, HER2-negative breast cancer who were treated with a GnRH agonist and tamoxifen; patients with pathologic N2 and those who received neoadjuvant chemotherapy were excluded. After 1:1 PSM of patients who underwent GnRH agonist treatment and tamoxifen with versus without chemotherapy, 122 patients from these 2 groups were analyzed. Survival rates were calculated using the Kaplan-Meier method and compared via the log-rank test.
After PSM, there were no significant differences in several baseline characteristics between the 2 groups. After a median follow-up of 62.8 months, the patients in both groups demonstrated similar outcomes with no significant difference in disease-free survival (P = 0.596).
Patients derived no significant survival benefit from undergoing a chemotherapy regimen before receiving tamoxifen and GnRH agonist therapy compared to forgoing such chemotherapy.


Adjuvant chemotherapy; Breast neoplasms; Gonadotropin-releasing hormone; Propensity score; Tamoxifen


  • Fig. 1 Disease-free survival (DFS) before propensity score-matching analysis. Endocrine therapy includes gonadotropin-releasing hormone agonist plus tamoxifen.

  • Fig. 2 Disease-free survival (DFS) after propensity score-matching analysis. Endocrine therapy includes gonadotropin-releasing hormone agonist plus tamoxifen.

  • Fig. 3 Invasive disease-free survival (DFS) before propensity score-matching analysis. Endocrine therapy includes gonadotropin-releasing hormone agonist plus tamoxifen.

  • Fig. 4 Invasive disease-free survival (DFS) after propensity score-matching analysis. Endocrine therapy includes gonadotropin-releasing hormone agonist plus tamoxifen.


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