Abstract
BackgroundAnthracycline-based adjuvant chemotherapy improves survival in patients with high-risk node-negative breast cancer (BC). In this setting, prognostic factors predicting for treatment failure might help selecting among the different available cytotoxic combinations.MethodsBetween 1998 and 2008, 757 consecutive patients with node-negative BC treated in our institution with adjuvant FEC (5FU, epirubicin, cyclophosphamide) chemotherapy were identified. Data collection included demographic, clinico-pathological characteristics and treatment information. Molecular subtypes were derived from estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Scarff-Bloom-Richardson (SBR) grade. Disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) were estimated using the Kaplan-Meier Method, and prognostic factors were examined by multivariate Cox analysis.ResultsAfter a median follow-up of 70 months, the 5-year DFS, DDFS and OS were 90.6 % (95 % confidence interval (CI): 88.2–93.1), 92.8 % (95 % CI: 90.7–95) and 95.1 % (95 % CI, 93.3–96.9), respectively. In the multivariate analysis including classical clinico-pathological parameters, only grade 3 maintained a significant and independent adverse prognostic impact. In an alternative multivariate model where ER, PR and grade were replaced by molecular subtypes, only luminal B/HER2-negative and triple-negative subtypes were associated with reduced DFS and DDFS.ConclusionsNode-negative BC patients receiving adjuvant FEC regimen have a favorable outcome. Luminal B/HER2-negative and triple-negative subtypes identify patients with a higher risk of treatment failure, which might warrant more aggressive systemic treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1746-3) contains supplementary material, which is available to authorized users.
Highlights
Anthracycline-based adjuvant chemotherapy improves survival in patients with high-risk node-negative breast cancer (BC)
41 % of patients with human epidermal growth factor receptor 2 (HER2)-positive documented BC received trastuzumab after chemotherapy and radiotherapy completion, corresponding to 85 % of HER2-positive cases diagnosed after September 2005, when trastuzumab became available in the adjuvant setting in France, but less than 5 % of those diagnosed before this date
A similar independent dismal prognosis was identified for luminal B/HER2-negative and triple-negative subtypes, suggesting that these patients might be the best candidate to more aggressive adjuvant chemotherapy, including the more aggressive and costly anthracycline and taxanebased combination
Summary
Anthracycline-based adjuvant chemotherapy improves survival in patients with high-risk node-negative breast cancer (BC). In this setting, prognostic factors predicting for treatment failure might help selecting among the different available cytotoxic combinations. A few years later, anthracycline-based regimens were shown to further improve outcome over CMF, these effects being regarded as largely independent of main tumor characteristics such as estrogen receptor (ER) status, lymph node status and associated endocrine therapy [1]. At the end of 90’s, cyclophosphamideepirubicin-5FU (FEC) regimen became the reference combination in France for adjuvant chemotherapy in early BC, epirubicin 100 mg/m2 being shown as more effective than 50 mg/m2 in a comparative randomized trial [4]. Taxanes were incorporated to adjuvant anthracycline-based chemotherapy, with demonstrated benefits in disease-free survival (DFS) and overall survival (OS) when compared to anthracycline-based combinations in various comparative randomized trials [5, 6] and meta-analysis [7]
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