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Population-Based Study on Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer.

Abstract

BACKGROUND

Breast cancer subtype is a key determinant in treatment decision-making, and also effects survival outcome. In this population-based study, in-depth analyses were performed to examine the impact that breast cancer subtype and receipt of guideline-concordant adjuvant systemic therapy (AST) have on survival using a population-based cancer registry's data.

METHODS

Women aged ≥20 years with microscopically confirmed stage I-III breast cancer diagnosed in 2011 were identified from the Louisiana Tumor Registry. Breast cancer subtypes were categorized based on hormone receptor (HR) and HER2 status. Guideline-concordant treatment was defined using the NCCN Guidelines for Breast Cancer. Logistic regression was applied to identify factors associated with guideline-concordant AST receipt. Kaplan-Meier survival curves were generated to compare survival among subtypes by AST receipt status, and a semiparametric additive hazard model was used to verify the factors impacting survival outcome.

RESULTS

Of 2,214 eligible patients, most (70.8%) were HR+/HER2- followed by HR-/HER2- (14.4%), and 78.6% received guideline-concordant AST. Compared with patients with the HR+/HER2+ subtype, women with other subtypes were more likely to be guideline-concordant after adjusting for sociodemographic and clinical variables. Women with the HR-/HER2+ or HR-/HER2- subtype had a higher risk of any-cause and breast cancer-specific death than those with the HR+/HER2+ subtype. Those who did not receive AST had an additional adjusted hazard of 0.0191 (P=.0001) in overall survival and 0.0126 (P=.0011) in cause-specific survival compared with those who received AST.

CONCLUSIONS

Most patients received guideline-concordant AST, except for those with the HR+/HER2+ subtype. Patients receiving guideline-adherent adjuvant therapy had better survival outcomes across all breast cancer subtypes.

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  • Authors+Show Affiliations

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    aEpidemiology Program and Louisiana Tumor Registry, School of Public Health, and.

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    aEpidemiology Program and Louisiana Tumor Registry, School of Public Health, and.

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    aEpidemiology Program and Louisiana Tumor Registry, School of Public Health, and.

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    aEpidemiology Program and Louisiana Tumor Registry, School of Public Health, and.

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    bHematology and Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

    aEpidemiology Program and Louisiana Tumor Registry, School of Public Health, and.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31200362

    Citation

    Hsieh, Mei-Chin, et al. "Population-Based Study On Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer." Journal of the National Comprehensive Cancer Network : JNCCN, vol. 17, no. 6, 2019, pp. 676-686.
    Hsieh MC, Zhang L, Wu XC, et al. Population-Based Study on Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer. J Natl Compr Canc Netw. 2019;17(6):676-686.
    Hsieh, M. C., Zhang, L., Wu, X. C., Davidson, M. B., Loch, M., & Chen, V. W. (2019). Population-Based Study on Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer. Journal of the National Comprehensive Cancer Network : JNCCN, 17(6), pp. 676-686. doi:10.6004/jnccn.2018.7272.
    Hsieh MC, et al. Population-Based Study On Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer. J Natl Compr Canc Netw. 2019 Jun 1;17(6):676-686. PubMed PMID: 31200362.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Population-Based Study on Cancer Subtypes, Guideline-Concordant Adjuvant Therapy, and Survival Among Women With Stage I-III Breast Cancer. AU - Hsieh,Mei-Chin, AU - Zhang,Lu, AU - Wu,Xiao-Cheng, AU - Davidson,Mary B, AU - Loch,Michelle, AU - Chen,Vivien W, PY - 2018/09/04/received PY - 2019/01/09/accepted PY - 2019/6/15/entrez PY - 2019/6/15/pubmed PY - 2019/6/15/medline SP - 676 EP - 686 JF - Journal of the National Comprehensive Cancer Network : JNCCN JO - J Natl Compr Canc Netw VL - 17 IS - 6 N2 - BACKGROUND: Breast cancer subtype is a key determinant in treatment decision-making, and also effects survival outcome. In this population-based study, in-depth analyses were performed to examine the impact that breast cancer subtype and receipt of guideline-concordant adjuvant systemic therapy (AST) have on survival using a population-based cancer registry's data. METHODS: Women aged ≥20 years with microscopically confirmed stage I-III breast cancer diagnosed in 2011 were identified from the Louisiana Tumor Registry. Breast cancer subtypes were categorized based on hormone receptor (HR) and HER2 status. Guideline-concordant treatment was defined using the NCCN Guidelines for Breast Cancer. Logistic regression was applied to identify factors associated with guideline-concordant AST receipt. Kaplan-Meier survival curves were generated to compare survival among subtypes by AST receipt status, and a semiparametric additive hazard model was used to verify the factors impacting survival outcome. RESULTS: Of 2,214 eligible patients, most (70.8%) were HR+/HER2- followed by HR-/HER2- (14.4%), and 78.6% received guideline-concordant AST. Compared with patients with the HR+/HER2+ subtype, women with other subtypes were more likely to be guideline-concordant after adjusting for sociodemographic and clinical variables. Women with the HR-/HER2+ or HR-/HER2- subtype had a higher risk of any-cause and breast cancer-specific death than those with the HR+/HER2+ subtype. Those who did not receive AST had an additional adjusted hazard of 0.0191 (P=.0001) in overall survival and 0.0126 (P=.0011) in cause-specific survival compared with those who received AST. CONCLUSIONS: Most patients received guideline-concordant AST, except for those with the HR+/HER2+ subtype. Patients receiving guideline-adherent adjuvant therapy had better survival outcomes across all breast cancer subtypes. SN - 1540-1413 UR - https://www.unboundmedicine.com/medline/citation/31200362/Population-Based_Study_on_Cancer_Subtypes,_Guideline-Concordant_Adjuvant_Therapy,_and_Survival_Among_Women_With_Stage_I-III_Breast_Cancer L2 - https://jnccn.org/doi/10.6004/jnccn.2018.7272 DB - PRIME DP - Unbound Medicine ER -