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

Authors:
Mei-Chin Hsieh Epidemiology Program and Louisiana Tumor Registry, School of Public Health, and

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Lu Zhang Epidemiology Program and Louisiana Tumor Registry, School of Public Health, and

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Xiao-Cheng Wu Epidemiology Program and Louisiana Tumor Registry, School of Public Health, and

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Mary B. Davidson Epidemiology Program and Louisiana Tumor Registry, School of Public Health, and

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Michelle Loch Hematology and Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

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Vivien W. Chen Epidemiology Program and Louisiana Tumor Registry, School of Public Health, and

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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.

Submitted September 4, 2018; accepted for publication January 9, 2019.

Author contributions: Study concept: Hsieh, Chen. Study design: Hsieh, Wu. Data collection and quality assessment: Davidson. Data analysis: Hsieh, Zhang. Guidance on clinical practice of breast cancer treatment: Loch. Writing—original draft and revision: Hsieh. Writing—review and editing: Zhang, Wu, Davidson, Loch, Chen.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported in part by the CDC Cooperative Agreements of the National Program of Cancer Registries (grant/award number: U58DP003915) in conjunction with a CDC Comparative Effectiveness Research contract to ICF (grant/award number: 635243-10S-1566) and NCI’s contract number HHSN2612018000071.

Disclaimer: The findings and conclusions are those of the authors and do not necessarily represent the official position of their affiliations, the CDC, or NCI.

Correspondence: Mei-Chin Hsieh, PhD, Epidemiology Program and Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier Street, New Orleans, LA 70112. Email: mhsieh@lsuhsc.edu
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  • Expand
  • 1.

    Perou CM, Sørlie T, Eisen MB, et al.. Molecular portraits of human breast tumours. Nature 2000;406:747752.

  • 2.

    Sørlie T, Perou CM, Tibshirani R, et al.. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001;98:1086910874.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Sotiriou C, Neo SY, McShane LM, et al.. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA 2003;100:1039310398.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Sotiriou C, Pusztai L. Gene-expression signatures in breast cancer. N Engl J Med 2009;360:790800.

  • 5.

    Carey LA, Perou CM, Livasy CA, et al.. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 2006;295:24922502.

  • 6.

    Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:16871717.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Berry DA, Cirrincione C, Henderson IC, et al.. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 2006;295:16581667.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al.. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005;353:16591672.

  • 9.

    Slamon D, Eiermann W, Robert N, et al.. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 2011;365:12731283.

  • 10.

    Harris L, Fritsche H, Mennel R, et al.. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007;25:52875312.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gradishar WJ, Anderson BO, Abraham J, et al.. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1.2019. Accessed March 15, 2019. To view the most recent version, visit NCCN.org.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Wu XC, Lund MJ, Kimmick GG, et al.. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 2012;30:142150.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Guy GP Jr, Lipscomb J, Gillespie TW, et al.. Variations in guideline-concordant breast cancer adjuvant therapy in rural Georgia. Health Serv Res 2015;50:10881108.

  • 14.

    Zurawska U, Baribeau DA, Giilck S, et al.. Outcomes of HER2-positive early-stage breast cancer in the trastuzumab era: a population-based study of Canadian patients. Curr Oncol 2013;20:e539545.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Chen VW, Eheman CR, Johnson CJ, et al.. Enhancing cancer registry data for comparative effectiveness research (CER) project: overview and methodology. J Registry Manag 2014;41:103112.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Howlader N, Altekruse SF, Li CI, et al.. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst 2014;106:pii:dju055.

  • 17.

    Paik S. Development and clinical utility of a 21-gene recurrence score prognostic assay in patients with early breast cancer treated with tamoxifen. Oncologist 2007;12:631635.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Sparano JA, Paik S. Development of the 21-gene assay and its application in clinical practice and clinical trials. J Clin Oncol 2008;26:721728.

  • 19.

    Quan H, Sundararajan V, Halfon P, et al.. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:11301139.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    National Cancer Institute. SEER cause-specific death classification. Available at: http://seer.cancer.gov/causespecific/index.html. Accessed September 10, 2017.

    • PubMed
    • Export Citation
  • 21.

    American College of Surgeons, Commission on Cancer. Facility Oncology Registry Data Standards. Revised for 2011. Available at: https://www.facs.org/∼/media/files/quality%20programs/cancer/coc/fords/fords_for_2011_01012011.ashx. Accessed May 25, 2017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Lin DY, Ying Z. Semiparametric analysis of the additive risk model. Biometrika 1994;81:6171.

  • 23.

    Schaubel DE, Wei G. Fitting semiparametric additive hazards models using standard statistical software. Biom J 2007;49:719730.

  • 24.

    Klein JP, Moeschberger ML. Survival Analysis: Techniques for Censored and Truncated Data, 2nd edition. New York, NY: Springer-Verlag; 1997.

  • 25.

    Xie X, Strickler HD, Xue X. Additive hazard regression models: an application to the natural history of human papillomavirus. Comput Math Methods Med 2013;796270. http://dx.doi.org/10.1155/2013/796270.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Collaborative Stage Data Collection System, Version 02.05. https://cancerstaging.org/cstage/schema/Pages/version0205.aspx. Accessed May 25, 2017.

    • PubMed
    • Export Citation
  • 27.

    Verschoor AM, Kuijer A, Verloop J, et al.. Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level. Breast Cancer Res Treat 2016;159:357365.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    O’Brien KM, Cole SR, Tse CK, et al.. Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 2010;16:61006110.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Parise CA, Caggiano V. Breast cancer survival defined by the ER/PR/HER2 subtypes and a surrogate classification according to tumor grade and immunohistochemical biomarkers. J Cancer Epidemiol 2014;2014:469251.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Fallahpour S, Navaneelan T, De P, et al.. Breast cancer survival by molecular subtype: a population-based analysis of cancer registry data. CMAJ Open 2017;5:E734739.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Haque R, Ahmed SA, Inzhakova G, et al.. Impact of breast cancer subtypes and treatment on survival: an analysis spanning two decades. Cancer Epidemiol Biomarkers Prev 2012;21:18481855.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Haffty BG, Yang Q, Reiss M, et al.. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol 2006;24:56525657.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Shim HJ, Kim SH, Kang BJ, et al.. Breast cancer recurrence according to molecular subtype. Asian Pac J Cancer Prev 2014;15:55395544.

  • 34.

    Leone J, Leone BA, Leone JP. Adjuvant systemic therapy in older women with breast cancer. Breast Cancer (Dove Med Press) 2016;8:141147.

  • 35.

    Clark TG, Bradburn MJ, Love SB, et al.. Survival analysis part I: basic concepts and first analyses. Br J Cancer 2003;89:232238.

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