Background: With greater awareness and increased screening, cancers are increasingly being diagnosed at stage I. Women with these small node-negative tumours have excellent survival prospects after surgery, but many women, especially those with triple-negative and human epidermal growth factor receptor (HER)-2-positive tumours, still receive adjuvant systemic treatments to reduce the recurrence risk. Aims: We review the outcomes of women diagnosed with stage I (T1N0M0) tumours in our unit and examine the effect of systemic chemotherapy with/without targeted therapy on recurrence patterns and survival outcomes. Results: We reviewed 643 women diagnosed with T1N0M0 disease over a 10-year period. Five-year recurrence-free survival (RFS) was 96.6% and the 10-year RFS was 95.5%. Recurrence occurred in 4.7% of the women and was limited to locoregional sites in two-thirds of the instances. Systemic recurrences developed in 12 women, all of whom had ER-positive/HER2-negative disease. The mode of surgery emerged as the only independent predictor of recurrence. Recurrence was highest in women treated with wide local excision (WLE) alone (p< 0.05), but not in those who had received breast radiation after WLE (p= 0.112). Systemic chemotherapy, with or without anti-HER2 therapy, was discussed with 334 women, of whom 50.6% received the treatment; these women were more often younger and had triple-negative or HER2-positive tumours (p< 0.001). Women who received chemotherapy showed a non-significant tendency to develop locoregional recurrence (p= 0.104), but the number of systemic recurrences were similar to those documented in women who had not received chemotherapy. Chemotherapy and/or targeted treatment was not observed to have a significant effect on 5-year recurrence-free survival (p= 0.444). Conclusions: Stage I cancers have excellent survival outcomes. An optimal local surgical treatment is important and we did not find chemotherapy and/or targeted therapy to produce any significant differences in survival.
背景：随着认知度的提高和筛查的加强，越来越多的癌症在I期被诊断出来。患有这些小型淋巴结阴性肿瘤的女性在手术后具有极佳的生存前景，但许多女性，尤其是三阴性及人表皮生长因子受体（HER）-2阳性肿瘤患者，仍接受辅助性全身治疗以降低复发风险。目的：我们回顾了本中心诊断为I期（T1N0M0）肿瘤女性的治疗结果，并探讨了含/不含靶向治疗的全身化疗对复发模式及生存结局的影响。结果：我们回顾了10年间诊断为T1N0M0疾病的643名女性患者。五年无复发生存率（RFS）为96.6%，十年RFS为95.5%。4.7%的患者出现复发，其中三分之二仅限于局部区域复发。12名患者出现全身性复发，且均为ER阳性/HER2阴性患者。手术方式成为复发的唯一独立预测因素。仅接受广泛局部切除术（WLE）治疗的患者复发率最高（p<0.05），而WLE术后接受乳腺放疗的患者复发率未见显著升高（p=0.112）。共有334名患者被建议接受含/不含抗HER2治疗的全身化疗，其中50.6%接受了治疗；这些患者更年轻且多为三阴性或HER2阳性肿瘤（p<0.001）。接受化疗的患者出现局部区域复发的趋势无统计学意义（p=0.104），但全身性复发数量与未接受化疗的患者相似。未观察到化疗和/或靶向治疗对五年无复发生存率有显著影响（p=0.444）。结论：I期癌症具有极佳的生存结局。优化局部手术治疗至关重要，而本研究未发现化疗和/或靶向治疗对生存率产生显著影响。
Evaluating Treatment Outcomes in Women with Node-Negative T1 Breast Cancers
肿瘤(癌症)患者之家