Impact of adjuvant endocrine therapy on disease-free survival in early triple-positive breast cancer: a multicenter retrospective cohort study of the Turkish oncology group.
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Seyyar Mustafa, Şancı Pervin Can, Doğan Akif, Biter Sedat, Köşeci Tolga, Balçık Onur Yazdan, Karabel Sinem Solmaz, Kalem Ali, Akosman Cengiz, Pilancı Kezban Nur, Onur İlknur Deliktaş, Arslan Ülkü Yalçıntaş, Kemal Yasemin, Avcı Tugay, Şahbazlar Mustafa, Akay Seval, Kahraman Emir Gökhan, Bayramgil Ayberk, Altıntaş Yunus Emre, Tünbekici Salih, Göker Erdem, Çolak Canan, Demir Teyfik, Demirağ Güzin, Güneysu Gökçe Gül, Aykan Musa Barış, Nazlı İsmail, Alkan Onur, Ökten İlker Nihat, Çolak Rumeysa, Yılmaz Mesut, Gür Hasibe Bilge, Hacıbekiroğlu İlhan, Sönmez Müge, Özyurt Neslihan, Aydın Okan, Ertürk Kayhan, Şahin Elif, Karakayalı Anıl, Baydar Ece, Çıtakkul İlkay, Emin Gamze, Yıldırım Atila, Gülmez Ahmet, Özberk Uğur, Algın Efnan, Köseoğlu Çağlar, Uzundere Fatma Keskin, Urakçı Zuhat, Akpunar Melih, Alkan Ali, Süner Ali, Peker Pınar, Camadan Yasemin Aydınalp, Can Lamia Şeker, Telli Tuğba Akın, Majidova Nargiz, Uzun Mehmet, Özkan Merve Kuday, Baykara Meltem, Güzel Halil Göksel, Yıldırım Hasan Çağrı, Kefeli Umut, Çabuk Devrim, Kus Tulay
Аннотация
METHODS: This multicenter retrospective cohort study included 1044 early-stage TPBC patients (stage II-III) treated with neoadjuvant chemotherapy and HER2-targeted therapy between 2007 and 2024. Disease-free survival (DFS) was analyzed using Kaplan-Meier estimates and Cox regression models, with separate multivariate analyses for premenopausal (n = 474) and postmenopausal (n = 570) patients.
RESULTS: At a median follow-up of 52 months, the 5-year DFS was 88.2% and the pCR rate was 44.3%. Residual disease was the strongest prognostic factor in both menopausal groups. In premenopausal patients, low ER expression (< 50%; HR 2.202; p = 0.003) and stage III disease (HR 2.722; p < 0.001) were independent adverse prognostic factors. Endocrine therapy type was associated with DFS on unadjusted analysis (log-rank p = 0.021) but was not significant after multivariable adjustment (adjusted overall p = 0.069). Although tamoxifen plus LHRH agonist showed a numerically higher recurrence risk than tamoxifen alone in exploratory subgroup comparison (HR 2.124; 95% CI 1.093-4.129; p = 0.026), this finding should be interpreted with caution given the non-significant overall association. In postmenopausal patients, stage III disease was the only independent adverse factor among baseline clinicopathological variables (HR 2.225; p = 0.003), and endocrine therapy type was not associated with DFS (log-rank p = 0.751; adjusted overall p = 0.614).
CONCLUSIONS: In this large real-world TPBC cohort, residual disease was the dominant prognostic factor regardless of menopausal status. Endocrine therapy type was not independently associated with DFS after multivariable adjustment in either menopausal group. These findings are hypothesis-generating and should not guide endocrine therapy selection; prospective studies are warranted in premenopausal TPBC.