Daily Practice Management of pT1a-b pN0 Breast Carcinoma: A Prospective French ODISSEE Cohort Study.

Abstract

BACKGROUND:

Most breast cancer (BC) tumors ≤10 mm have an excellent prognosis. The subgroups with a higher risk for distant recurrence requiring adjuvant systemic therapy are not precisely defined in current international guidelines.

PATIENTS AND METHODS:

The OBSERVATOIRE DES PETITS CANCERS DU SEIN HER2 +/- (ODISSEE) study was a prospective, multicenter, cohort study that aimed to describe the daily adjuvant management and outcome of 616 patients with unifocal, invasive pT1a-b pN0 nonmetastatic BC who underwent surgery.

RESULTS:

At the time of diagnosis, the median age of patients was 61 years. Tumor was detected on imaging or during a screening program in 397 patients (64.6%). Most patients (96%) underwent conservative surgery with sentinel node biopsy (89%), completed with axillary lymph node dissection in 15%. At inclusion, 82% of tumors were pT1b, 73% were pN0 (i-), 53% were Scarff-Bloom-Richardson Grade I, 91% were estrogen receptor (ER)-positive, 5% overexpressed/amplified HER2, and 5% were triple negative (TNBC). Adjuvant treatments were radiotherapy (95%), hormone therapy (82%), chemotherapy (7%), and trastuzumab (3.5%). In patients with TNBC and HER2-positive BC, chemotherapy and trastuzumab (if needed) were administered in 45% and 68%, respectively. After 5 years of follow-up, 7 patients had contralateral BC, 7 had locoregional recurrence, and 1 had distant metastasis. At 5 years, overall survival, disease-free survival, and recurrence-free survival were: 98.4% (96.9%-99.1%), 94.7% (92.4%-96.3%), and 97.1% (95.2%-98.2%), respectively.

CONCLUSION:

This prospective cohort study showed that in France, the routine practice in pT1a-b pN0 breast cancers follows international standard guidelines for practice including conservative surgery followed by radiotherapy and endocrine therapy for ER-positive patients. Adjuvant chemotherapy with or without trastuzumab was used but their benefit in breast cancer of ≤10 mm remains controversial.

• Authors: Florence Dalenc, Frédérique Penault-Llorca, Monique Cohen, Gilles Houvenaeghel, Jean-Marc Piat, Philippe Liegeois, Laurent Puyuelo, Jean-Philippe Suchaud, Mohammed Zouai, Magali Lacroix-Triki, Nina Radosevic-Robin, Chahinez Benkanoun, Hanane Attar-Rabia, Marie-Pierre Chauvet, Joseph Gligorov, Yazid Belkacemi
• Journal: Clinical breast cancer (Clin Breast Cancer) Vol. 17 Issue 2 Pg. 107-116 (Apr 2017) ISSN: 1938-0666 [Electronic] United States
• PMID: 27856201 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents, Hormonal
• Biomarkers, Tumor
• ESR1 protein, human
• Estrogen Receptor alpha
• ERBB2 protein, human
• Receptor, ErbB-2
• Trastuzumab

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Hormonal (therapeutic use)
• Biomarkers, Tumor (analysis)
• Breast Neoplasms (mortality, pathology, therapy)
• Chemotherapy, Adjuvant
• Disease-Free Survival
• Estrogen Receptor alpha (metabolism)
• Female
• Follow-Up Studies
• France (epidemiology)
• Humans
• Middle Aged
• Neoplasm Grading
• Neoplasm Recurrence, Local (epidemiology)
• Neoplasm Staging
• Practice Guidelines as Topic
• Prognosis
• Prospective Studies
• Radiotherapy, Adjuvant
• Receptor, ErbB-2 (metabolism)
• Self Report
• Trastuzumab (therapeutic use)
• Treatment Outcome
• Young Adult