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

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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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