Impact of Adjuvant Chemotherapy on Breast Cancer Survival: A Real-World Population

• Published in: PloS one Vol. 10; no. 7; p. e0132853
• Main Authors: Rossi, Lea, Stevens, Denise, Pierga, Jean-Yves, Lerebours, Florence, Reyal, Fabien, Robain, Mathieu, Asselain, Bernard, Rouzier, Roman
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.07.2015; Public Library of Science (PLoS)
• Subjects: Adjuvant chemotherapy; Adult; Aged; Aged, 80 and over; Analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Clinical medicine; Clinical trials; Collaboration; Family medical history; Female; Health risk assessment; Humans; Invasiveness; Metastases; Metastasis; Middle Aged; Mortality; Multivariate analysis; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Staging; Patients; Population; Prospective Studies; Randomization; Studies; Survival; Survival analysis; Tumor Burden; Variance analysis; Womens health; World population
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0132853

The impact of adjuvant chemotherapy on breast cancer prognosis has been demonstrated in randomized trials, but its impact is unknown in real-world populations. The aim of this study was to evaluate the effect of adjuvant chemotherapy on the survival of breast cancer patients in an unselected population. This prospective cohort study included 32,502 women treated at the Institut Curie between 1981 and 2008 for a first invasive breast cancer without metastasis. The patients were matched based on their propensity score to receive adjuvant chemotherapy. The matching generated a subsample of 9,180 patients with an overlapping propensity score. In the group without chemotherapy, the overall survival (OS) rates at 5 and 10 years of follow-up were 87.6% (95% CI [86.7-88.6]) and 75.0% (95% CI [73.6-76.5]), respectively, versus 92.1% (95% CI [91.3-92.9]) and 81.9% (95% CI [80.6-83.2]), respectively, in the chemotherapy group. Distant disease-free survival (DDFS) was significantly improved in the five first years (absolute benefit of 3.5%). In a multivariate analysis, adjuvant chemotherapy was associated with better OS (HR = 0.75, 95% CI [0.69-0.83], p<0.0001) and DDFS (HR = 0.82, 95% CI [0.75-0.90], p<0.0001). Adjuvant chemotherapy significantly improves OS and DDFS rates in an unselected population, in accordance with previous results reported by randomized trials.