Breast Cancer-specific Survival Rates Research Articles

Prognosis and trends in chemotherapy use for patients with stage IA triple-negative breast cancer (TNBC): A population-based study.

510 Background: Outcomes for patients with stage IA TNBC in the modern era remain poorly characterized, and the benefit and utilization of adjuvant chemotherapy (chemo) in this setting remains controversial. Methods: We analyzed data from women diagnosed with pathological stage IA TNBC in the Surveillance, Epidemiology, and End Results (SEER) database during 2010 to 2019. We evaluated the associations of adjuvant chemo with breast-cancer specific survival (BCSS) stratified by tumor size, using multivariate cox models adjusted for tumor size (overall cohort only), age at diagnosis, race, tumor grade, histology, radiation, marital status, income, and rurality. Frequency of chemo use over time was examined by tumor size. Multivariate logistic regression assessed variables associated with chemo administration. Results: In total, we examined data from 8,601 women with stage IA TNBC. Median age at diagnosis was 62 years. Most patients had high-grade tumors (70.1%), ductal histology (92.8%), and received adjuvant chemo (61.6%). Median follow up was 48 months (IQR: 20 – 83). The use of chemo significantly increased during 2010-2019 for both T1b tumors (p for trend = 0.001) and T1c tumors (p for trend < 0.001), with 52.5% and 63% of the patients with T1b and T1c TNBCs receiving chemo in 2010, respectively, compared with 60.5% and 71.1% in 2019. No significant differences were observed in the use of chemo for T1mic (p for trend = 0.567) and T1a (p for trend = 0.637) tumors, with low utilization seen in both cohorts (9.5% overall in T1mic, 22.5% overall in T1a). Variables associated with chemo use included younger age, white race, married status, higher income, more recent diagnosis, higher tumor grade, ductal histology, and larger tumor size (all p < 0.02). Overall, 5-year BCSS was high across T groups ( > 90%; Table). Receiving chemo (vs. none/unknown) was associated with an improved 5-year BCSS (adjusted HR for BCSS = 0.70, p = 0.006). For T1c tumors specifically, adjuvant chemo (vs. none/unknown) was also associated with BCSS (adjusted HR 0.64, p = 0.002). The small number of BCSS events precluded comparisons for other tumor size subgroups. Table shows sample sizes and 5-year BCSS rate by chemo receipt for each T group. Conclusions: In a large population-based cohort of patients with stage IA TNBC, we observed excellent 5-year BCSS outcomes, supporting the good prognosis of this patient population. The use of adjuvant chemo increased over time for T1b and T1c TNBCs, and was associated with improved BCSS for T1c tumors, although evaluation of benefit is limited by the inherent treatment bias in registry data. [Table: see text]

Development and validation of nomograms for predicting survival outcomes in patients with T1-2N1 breast cancer to identify those who could not benefit from postmastectomy radiotherapy.

In this study, we aimed to develop and validate nomograms for predicting the survival outcomes in patients with T1-2N1 breast cancer to identify the patients who could not benefit from postmastectomy radiotherapy (PMRT). Data from 10191 patients with T1-2N1 breast cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Of them, 6542 patients who had not received PMRT formed the training set. Concurrently, we retrospectively enrolled 419 patients from the Affiliated Hospital of North Sichuan Medical College (NSMC), and 286 patients who did not undergo PMRT formed the external validation set. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses were used for selecting prognostic factors in the training set. Using the selected factors, two prognostic nomograms were constructed. The nomograms' performance was assessed using the concordance index (C-index), calibration curves, decision curve analysis (DCA), and risk subgroup classification. The stabilized inverse probability of treatment weights (IPTWs) was used to balance the baseline characteristics of the different risk groups. Finally, the survival outcomes and effectiveness of PMRT after IPTW adjustment were evaluated using adjusted Kaplan-Meier curves and Cox regression models. The 8-year overall survival (OS) and breast cancer-specific survival (BCSS) rates for the SEER cohort were 84.3% and 90.1%, with a median follow-up time of 76 months, while those for the NSMC cohort were 84.1% and 86.9%, with a median follow-up time of 73 months. Moreover, significant differences were observed in the survival curves for the different risk subgroups (P < 0.001) in both SEER and NSMC cohorts. The subgroup analysis after adjustment by IPTW revealed that PMRT was significantly associated with improved OS and BCSS in the intermediate- (hazard ratio [HR] = 0.72, 95% confidence interval [CI]: 0.59-0.88, P=0.001; HR = 0.77, 95% CI: 0.62-0.95, P = 0.015) and high- (HR=0.66, 95% CI: 0.52-0.83, P<0.001; HR=0.74, 95% CI: 0.56-0.99, P=0.039) risk groups. However, PMRT had no significant effects on patients in the low-risk groups. According to the prognostic nomogram, we performed risk subgroup classification and found that patients in the low-risk group did not benefit from PMRT.

Abstract P4-03-06: Clinical and socioeconomic disparities in treatment and survival between Hispanic and non-Hispanic Black women with non-metastatic Triple-Negative Breast Cancer

Abstract Background: Breast cancer(BC) is a common female malignancy [1]. Triple-negative breast cancer (TNBC) is the least common (10-15% of cases)[2], but the most aggressive subtype. TNBC accounts for 5% of all-cancer-related deaths every year[3, 4].Hispanic women are 1.3 more likely to develop TNBC [3, 5]. Whether Hispanic and non-Hispanic patients suffering from TNBC show different survival. We aim: (1) to evaluate the differences in overall (OS) and breast cancer specific survival(BCSS) between Hispanic(H) and non-Hispanic black (NHB) women in non-metastatic TNBC, and (2) to assess the contribution of sociodemographic, clinical, and neighborhood factors to TNBC survival disparities. Methods: With the SEER database of the National Cancer Institute, we identified 4271 (39%) H and 6594 (61%) NHB patients who were diagnosed with non-metastatic TNBC between 2010 and 2016. Patients with tumor in situ were excluded from the analysis. Logistic regression was used to identify odd ratios for treatment modalities. Kaplan-Meir methods were used to estimate OS and BCSS. Competing risk analysis was used to asses the association between race/ethnicity and risk of breast cancer mortality adjusting for age, insurance, social, SDI, rurality, BC stage, tumor grade, surgery, chemotherapy, and radiation therapy. Results: The mean age at diagnosis for H vs. NHB was 53 and 56 years, respectively (p &amp;lt; 0.001). 54% of Hispanics were married vs. 35 % of NHB, p &amp;lt; 0.001. Tumor size &amp;gt; 5 cm was present in 14% NHB vs. 12% H patients, p &amp;lt; 0.001. Grade I tumors were only 1 % in both groups, grade II were 13% and grade III-IV were 82% also in both groups, p &amp;gt;0.99. H (28% stage I, 50% stage II) had more advance disease as compared to NHB (30% stage I, 48% stage II) [p &amp;lt; 0.001]. Private insurance was more common in NHB than H (74% vs. 66%, p &amp;lt; 0.001). Rural residence was more common in NHB than H (8% vs. 3 %, p&amp;lt; 0.001). High level of SDI was more common in H as compared to NHB(43% vs. 36%, p &amp;lt; 0.001). Surgery was performed in 92% of NHB and 91% of H, p = 0.03. Radiation was given to 54% of NHB and 43% of H, p &amp;lt; 0.001, while chemotherapy was given to 79% of NHB and 79% of H patients, p = 0.54. After adjusting for clinicopathological features, the odds ratio (ORs) for receiving surgery, radiation, and chemotherapy for NHB as compared to H were 0.9 (p = 0.32), 1.57 (p &amp;lt; 0.001), and 0.89 (p = 0.03), respectively. The 5-year OS and BCSS rates were higher in H as compared to NHB(OS 76% vs. 72%, p &amp;lt; 0.001; BCSS 81% vs. 78%, p &amp;lt; 0.001). For stage I patients, neither 5-year OS (86% vs. 89%, p= 0.054) nor BCSS (91% vs. 93%, p= 0.37) was different between NHB and H patients. For stage II and III patients, the 5-year OS rates for Hispanics vs. NHB were (79% vs 74%, p &amp;lt; 0.001) and (51% vs 45%, p &amp;lt; 0.004), respectively. After adjusting for age, marital status, insurance, stage, grade, treatment, SDI, rurality; NHB have higher risk of BC death as compared to H patients (subdistribution Hazard Ratio (HR) = 1.39; 95% CI 1.2 – 1.56, p &amp;lt; 0.001). The association between race/ethnicity and risk of breast cancer death was not affected by age (p=0.44), insurance(p=0.89), SDI(p=0.40), or living in a rural area(p=0.14). The risk of BC death between NHB and H was even higher for patients who did not receive radiation (HR 1.5) than in those who received radiation (HR 1.2). The risk of BC death between NHB and H was also higher for patients who did not undergo surgery (HR 1.7) than in those who underwent surgery (HR 1.3). Conclusions: In patients with non-metastatic TNBC, H patients present with increased rates of high-grade and advanced stage tumors than NHB. NHB are 57% more likely to receive radiation and 11% less likely to receive chemotherapy than H women. NHB patients have a 39% higher risk of BC death as compared to H even after adjusting for clinicopathological, treatment and socioeconomic factors. Future studies need to assess potential etiologies for racial disparities in BC outcomes such as differences in tumor microenvironment, access to healthcare, tumor biology and treatment efficacy. Citation Format: Alvaro Alvarez Soto, Ana Maria Bernal, Jesus Anampa Mesias. Clinical and socioeconomic disparities in treatment and survival between Hispanic and non-Hispanic Black women with non-metastatic Triple-Negative Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-06.

Abstract P6-03-06: Determining prognostic factors and optimal surgical intervention for young patients with triple-negative breast cancer

Abstract Background Triple-negative breast cancer (TNBC) is more frequently diagnosed in young patients, with an incidence of 26% of this population compared to 12% overall, and is characterized by high malignancy and poor prognosis. Limited data are available that contribute to a comprehensive summarization of the prognostic factors and the determination of surgical strategy that are associated with young patients with TNBC. We aimed to determine the optimal surgical approach (breast-conserving versus mastectomy) for patients aged &amp;lt; 40 years with TNBC and establish a prognostic model. Methods We performed a cohort study with a median follow-up of 31 months using the Surveillance, Epidemiology, and End Results (SEER) data of young patients &amp;lt; 40 years diagnosed with stage I–III TNBC between 2010 and 2016. A Cox proportional hazards model was used to investigate the effects of baseline characteristics on breast cancer-specific survival (BCSS) and overall survival (OS). To ensure that differences in outcomes were not based on baseline differences in demographic and clinical characteristics, we performed Kaplan–Meier analysis before and after propensity score matching (1:1). Subgroup analyses stratified by TNM stage as well as further propensity score matching analyses were performed. A nomogram was constructed from the multivariate logistic regression to incorporate all the prognostic factors to predict the BCSS rates of patients at 3 years and 5 years. Young patients &amp;lt; 40 years diagnosed with stage I–III TNBC between 2006 and 2016 in Shenzhen Second People’s Hospital (SSPH) were enrolled as external validation. Results A total of 2,854 patients from SEER dataset and 250 from SSPH were included in this study. On multivariable analysis, unmarried status, lack of health insurance, advanced T stage, advanced N stage, invasive lobular carcinoma or mixed histologic type, were all significantly associated with poor BCSS and OS. Young patients with TNBC were more likely to undergo mastectomy than breast-conserving surgery. Notably, patients with T1N0M0 or T2-4N+M0 tumors who underwent breast-conserving surgery achieved longer BCSS and OS than those who underwent mastectomy; however, the type of surgery did not influence survival rates among patients with T1N+M0 or T2-4N0M0 tumors. The nomogram was constructed by the five variables and passed the calibration and validation steps (C-index: 0.774 for training cohort and 0.768 for validation cohort). The area under the receiver operating characteristic curves (AUCs) predicting the 3-year and 5-year BCSS rates were calculated (0.783 and 0.774 in training cohort; 0.786 and 0.772 in validating cohort). Conclusions A localized surgical approach may be a superior option for young patients with TNBC, especially those with T1N0M0 and T2-4N+M0 tumors. Marital status, health insurance status, T stage, N stage, and histological type were independent prognostic factors, and a nomogram established based on these variables successfully predicted the 3- and 5-year survival probabilities among these patients. Citation Format: Yi-Zi Zheng, Yan Liu, Zhen-Han Deng, Guo-Wen Liu, Ni Xie. Determining prognostic factors and optimal surgical intervention for young patients with triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-03-06.

Abstract P1-01-01: The Role of Adjuvant Chemotherapy for Elderly Women with Triple-Negative Breast Cancer

Abstract Purpose: There is little evidence determining whether elderly patients (from 70 to 90 years old) with triple-negative breast cancer (TNBC) could benefit from adjuvant chemotherapy (AC). The objective of this study was to explore the effect of AC in these population following surgery. Methods: A total of 4610 patients were identified in the Surveillance, Epidemiology, and End Results database (2010-2018). Inverse probability of treatment weighting (IPTW) was used to reduce the selection bias. IPTW-adjusted Kaplan-Meiers survival analysis and Cox proportional hazards models were performed to compare breast cancer specific survival (BCSS) and overall survival (OS) in the two different treatment groups. Results: All eligible patients were divided into two groups, the chemotherapy (n=1989) and the observation (n=2621) groups. The percentage of patients receiving AC versus observation increased significantly from 2010 to 2018 (estimated annual percentage change, 1.49%; 95%CI, 0.75-2.16%, p=0.002). The 5-year IPTW-adjusted rates of BCSS and OS in AC group were better than that in observation group (BCSS: 82.32% vs. 78.42%, p=0.010; OS: 75.54% vs. 64.65%, p&amp;lt; 0.001). In IPTW-adjusted Cox proportional hazards regression analysis, elderly patients could benefit from AC (BCSS: HR, 0.77, 95%CI, 0.62-0.94, p=0.012; OS: HR, 0.66, 95%CI, 0.57-0.78, p&amp;lt; 0.001). AC was associated with a significant outcome benefit across year at diagnosis, marital status, stage, lymph node, surgery and radiation subgroups (all p&amp;lt; 0.05). Patients with T1ab could not benefit from AC. Conclusions: We show a BCSS and OS benefit from AC in old patients with TNBC. AC may remain a reasonable treatment approach in these specific patients. For the patients with T1ab, de-escalated treatment should be administrated with caution. It requires further randomized controlled trial to ensure the AC effectiveness for elderly TNBC patients. Citation Format: Tian Lan, Qiusheng Guo, Yunyan Lu, Junwei Gu, Xiying Shao, Haibin Xu, Zujian Hu. The Role of Adjuvant Chemotherapy for Elderly Women with Triple-Negative Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-01-01.

A matched case-control study of the prognosis of early breast cancer in patients with Li-Fraumeni syndrome (BREAST TP53)

IntroductionBreast cancer (BC) is the most common type of cancer in premenopausal women with germline TP53 pathogenic variants (mTP53) (Li Fraumeni syndrome - LFS). However, little is known about the BC prognosis in these patients. This study analyzed the BC-related oncologic outcomes of patients with LFS. MethodsWe evaluated a cohort of LFS patients with BC in comparison with a control cohort of BC patients with no pathogenic variant in a hereditary cancer panel. The primary endpoint was recurrence-free survival (RFS). Due to the risk of second malignancies in LFS, only locoregional and distant recurrences were considered events for RFS. Secondary endpoints included rates of contralateral BC, overall survival (OS), and breast cancer-specific survival (BCSS). ResultsForty-one patients were evaluated in the mTP53 group and 82 in the control group. Median age at BC diagnosis was 40 and 41 years, respectively. The mTP53 group received less adjuvant radiotherapy than the control group (63.4% vs 93.9%, P < 0.001). Other relevant baseline characteristics and treatment received were similar between groups. 5y-RFS rates were 79.4% in the mTP53 versus 93.6% in the control group (HR 2.43, 95%CI 0.74–8.01, P = 0.143); and were not impacted by the use of adjuvant radiotherapy. 5y-BCSS rates were 92.2% and 98.6%, respectively (HR 1.87, IC95% 0.25–13.48, P = 0.534). ConclusionsOur results showed no statistically significant difference in BC-related RFS and BCSS between patients with mTP53 and a control group with no pathogenic variant. Larger multicentric studies are warranted to confirm these results.

Aquaporin 5 (AQP5) expression in breast cancer and its clinicopathological characteristics.

The role of aquaporin water channels (AQPs) has become an area of great interest in human carcinogenesis. In this report, we have demonstrated the expression of AQP5 in breast cancer by analyzing 591 tissue samples with 7-year follow-ups. By immunochemistry analysis, AQP5 overexpression was observed in 36% (212/591 cases). Then, we have focused on the clinicopathologic variables among cancer tissue samples with strong AQP5 expression (3+ expression, 60/591 cases). The strong AQP5 expression was positively correlated with tumor grade in BCs (p<0.001) and was more frequent in ER/PR-negative BCs than positive ones (14.9% vs. 3.3% and 13.1% vs. 4.8%, respectively, both p<0.001), while Her2/neu-positive status was positively correlated with strong expression of AQP5 (p = 0.005). Of note, breast cancer patients with positive AQP expression (212/591 cases) showed a less favorable breast cancer specific survival rate over 7 years of follow and we further conclude that AQP5 expression is an independent molecular marker associated with worse clinical outcomes. By fluorescence in situ hybridization (FISH), we have identified evidence of gene amplification in 3 of 30 readable breast cancer and further conclude that, in breast cancer, at least some part of AQP5 overexpression is associated with an aberration in the genome level.

Validation study of a nomogram for predicting probability of low risk of MammaPrint results in women with clinically high-risk breast cancer

BackgroundMammaPrint (MMP) helps clinicians identify the ideal time for adjuvant treatment for patients with early HR+/HER2− breast cancer. We aimed to validate a nomogram designed to predict probability of low risk of MMP results and to evaluate the difference in survival outcome between two groups divided by nomogram score.MethodsIn this retrospective cohort study, we evaluated 172 patients from Asan Medical Center, Seoul, Korea, who underwent breast cancer surgery and MMP during 2020–2021. First, we validated the nomogram by calculating the area under the curve (AUC) and using calibration. Additionally, with the data of 1,835 T1-3N0-1M0 HR+/HER2− patients from Asan Medical Center during 2010–2013, we compared the disease-free survival (DFS), overall survival (OS), and breast cancer-specific survival (BCSS) rates by Kaplan−Meier analysis between the two groups divided by nomogram total point (TP) of 183.ResultsThe AUC calculated by validation of 172 patients was 0.73 (95% confidence interval [CI], 0.66–0.81). The discrimination and calibration of the prediction model were satisfactory following additional validation of 1835 patients. The high-risk and low-risk groups had different 5-year OS (97.9% vs. 98.1%, p = 0.056), DFS (98.6% vs. 99.4%, p = 0.008), and BCSS rates (98.6% vs. 99.4%, p = 0.002).ConclusionFor treatment decision-making among clinically high-risk patients with HR+/HER2− and node-positive disease, the nomogram showed satisfactory performance in predicting patients with low genomic risk. Survival outcome significantly differed between two groups divided by nomogram TP. More studies are needed to validate this model in international cohorts and large prospective cohorts from other institutions.

Outcomes in patients with non-invasive breast carcinoma.

Non-invasive breast carcinoma is considered to be localized disease and is distinguished from invasive ductal and lobular carcinomas. The local recurrence of non-invasive carcinoma after surgery may lead to development of invasive carcinoma and promote distant metastasis, which worsens the prognosis for breast cancer mortality. The distant metastasis of non-invasive carcinoma may involve the ductal microvasculature without invasion. The outcomes of non-invasive breast carcinoma were examined in this retrospective cohort study. Of 872 primary breast cancers diagnosed at a single center between May 2008 and March 2022, 93 (10.6%) were found to be non-invasive carcinomas and were examined in this study. The breast cancer recurrence and survival rates of patients with non-invasive carcinoma were analyzed retrospectively. The median follow-up period was 1891 (range, 5-4804) days. All patients underwent surgical treatment [mastectomy with sentinel lymph node biopsy (SLNB) and partial mastectomy with or without SLNB, tumorectomy, and microdochectomy]. Postoperatively, radiation therapy was administered to 73 (78.4%) of the patients and endocrine therapy was administered to 64 (81.0%) of 79 patients with hormone-receptor positivity. Of 26 patients who underwent partial mastectomy with SLNB, 24 (92.3%) showed isolated tumor cells in the SLNs on one-step nucleic acid amplification. Local recurrence was observed in three (0.3%) patients; no distant metastasis was observed. One patient died of a noncancerous disease. The overall survival rate was 98.0% and the breast cancer-specific survival rate was 100.0%. Non-invasive breast carcinoma, like invasive breast carcinoma, causes local recurrence, but has a good prognosis without distant metastasis. The clinical significance of isolated tumor cells in the SLNs as a systemic component of non-invasive breast carcinoma remains to be elucidated.

Effectiveness of adjuvant chemotherapy for elderly patients with triple-negative breast cancer.

There is little evidence determining whether elderly patients (from 70 to 90 years old) with triple-negative breast cancer could benefit from adjuvant chemotherapy (AC). This study explores the effect of AC in these population following surgery. A total of 4610 patients were identified in the Surveillance, Epidemiology, and End Results database (2010-2018). Multiple imputation by chained equations was performed to impute missing data. Inverse probability of treatment weighting (IPTW) was applied to reduce the selection bias. IPTW-adjusted Kaplan-Meiers survival analysis and Cox proportional hazards models were performed to compare breast cancer specific survival (BCSS) and overall survival (OS) in the two treatment groups. The patients were classified into the chemotherapy (n=1989) and the observation (n=2621) groups. The percentage of patients receiving AC versus observation increased significantly from 2010 to 2018 (estimated annual percentage change, 1.49%; 95%CI, 0.75-2.16%, p=0.002). The 5-year IPTW-adjusted rates of BCSS and OS in AC group were better than that in observation group (BCSS: 82.32% vs. 78.42%, p=0.010; OS: 75.54% vs. 64.65%, p<0.001). The patients could benefit from AC based on the results of IPTW-adjusted Cox proportional hazards regression analysis (BCSS: HR, 0.77, 95%CI, 0.62-0.94, p=0.012; OS: HR, 0.66, 95%CI, 0.57-0.78, p<0.001). AC was associated with a significant outcome benefit across the year at diagnosis, marital status, stage, lymph node, surgery, and radiation subgroups (all p<0.050). Patients with T1ab could not benefit from AC (p>0.050). In conclusion, we presented a BCSS and OS benefit from AC in elderly patients with triple-negative breast cancer (TNBC). AC remained a reasonable treatment approach in these specific patients. For the patients with T1ab, de-escalated treatment would be administrated with caution.

Prognostic Factors and a Model for Occult Breast Cancer: A Population-Based Cohort Study.

Occult breast cancer (OBC) is a special type of breast cancer of an unknown primary origin. Early stage OBC is treated as stage II-III breast cancer. Currently, there are no models for predicting the survival outcomes. Hence, we aimed to evaluate the role of the positive lymph node ratio (PLNR) in OBC and further establish and validate a prognostic nomogram. Patients with stage T0N+M0 breast cancer were enrolled from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox analyses were used to evaluate the effects of prognostic factors on breast-cancer-specific survival (BCSS), and a nomogram was established and validated for OBC. Overall, 843 patients were included, and the 5-year BCSS rate was 92.4%. Patients with a PLNR &lt; 0.54 had better BCSS rates than those with a PLNR ≥ 0.54. The nomogram combined clinicopathological parameters, including the PLNR, pN stage, and estrogen receptor status, and showed a higher accuracy than the TNM staging system in predicting the BCSS. The patients could be stratified into different risk groups based on their prognostic scores. Patients in the low-risk subgroup showed an improved BCSS compared those in the high-risk subgroup. In conclusion, the PLNR is an independent prognostic factor for OBC. The PLNR-based nomogram has a better predictive ability than the TNM staging system and could be of great value for the treatment of OBC and prediction of its prognosis.

Influence of advanced age on the prognosis of triple-negative breast cancer patients: A surveillance, epidemiology, and end results-based study.

Age at diagnosis has shown significant effect on the prognosis in breast cancer patients. However, whether age is an independent risk factor remains controversial. Furthermore, population-based estimates of age on the prognosis impact in triple-negative breast cancer are still lacking. The aim of this study was to analyze the influence of age and other factors on the prognosis and survival of triple-negative breast cancer patients. We used the surveillance, epidemiology, and end results program data from 2011 to 2014. A retrospective cohort study was conducted to investigate prognosis factors in triple-negative breast cancer. Patients were divided into two groups according to age at diagnosis: 75 + years (the elderly patients) and < 75 years (reference group). The clinicopathologic characteristics of different age groups were compared using Chi-square tests. Overall survival (OS) and breast cancer-specific survival were analyzed using the Kaplan-Meier method. Prognostic factors were compared using the Cox proportional hazards model. We also analyzed the difference of distant metastasis at initial diagnosis on every group. A total of 21,429 triple-negative breast cancer patients were included in our study. The mean breast cancer-specific survival time of triple-negative breast cancer was 70.5 months for the reference group and 62.4 months for the elderly group. Survival analysis showed that the breast cancer-specific survival rate was 78.9% for the reference group and 67.4% for the elderly group. The mean OS time was 69.0 months for the reference group and 52.3 months for the elderly group. The 5-year OS of triple-negative breast cancer patients was 76.4% for the reference group and 51.3% for the elderly group. The prognosis of elderly patients is much poor than reference group. Univariate Cox regression analysis showed that age, race, marital status, histological grade, stage, T, N, M, surgery, radiotherapy, and chemotherapy were risk factors for triple-negative breast cancer (TNBC) (P < 0.05). Multivariate Cox regression analysis showed that age, race, marital status, histological grade, stage, T, N, M, surgery, radiotherapy, and chemotherapy were independent risk factors for TNBC (P < 0.05). Age is an independent risk factor for the prognosis of TNBC patients. Elderly triple-negative breast cancer patients displayed obvious lower 5-year survival rate compared to reference group, even though they have better grade stage, minor tumor, less lymph node metastasis. The lower rate of marital status, radiotherapy, chemotherapy, surgery, and higher rate of metastasis at diagnosis must contribute to their poor outcome.

Comparison of Breast-Conserving Surgery vs. Mastectomy for Patients with Breast Cancer after Neoadjuvant Chemotherapy

<h3>Purpose/Objective(s)</h3> To compare recurrence and survival outcomes between breast-conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT). <h3>Materials/Methods</h3> A total of 730 eligible patients who underwent NACT between 2000 and 2014 were retrospectively reviewed. Of those, 104 (14.2%) patients received BCS and 626 (85.8%) patients received mastectomy. Locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS), Breast cancer - specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier method. The impact of BCS versus (vs) mastectomy on outcomes was assessed by multivariate Cox models and inverse probability of treatment weighting (IPTW) method by adjusting for age, clinical T stage, clinical N stage, NACT cycles, histological grade, lymphovascular invasion (LVI), molecular subtype/trastuzumab, ypT (pathologic tumor stage after NACT), ypN (pathologic lymph node stage after NACT), endocrine therapy, and adjuvant chemotherapy. Recurrence and survival curves before or after weighting were compared with the log rank test. <h3>Results</h3> The median follow-up was 87.4 months. The 5-year LRR, DM, DFS, BCSS and OS rates after BCS and mastectomy were 6.9% vs 7.6% (P = 0.805), 10.8% vs 19.9% (P = 0.145), 83.4% vs 78.2% (P = 0.514), 98.9% vs 90.4% (P = 0.005) and 98.9% vs 90.1% (P = 0.003), respectively. There were significant differences in distribution of most baseline characteristics between the BCS and mastectomy group. After IPTW adjustment, the clinical characteristics between two groups were comparable. Multivariate analysis showed that BCS had no significant impact on LRR (HR 1.08, 95% CI 0.48-2.43, P = 0.849), DM (HR 0.82, 95% CI 0.49-1.40, P = 0.473) and DFS (HR 1.12, 95% CI 0.70-1.80, P = 0.626) compared with mastectomy, but BCS significantly improved BCSS (HR 0.29, 95% CI 0.09-0.92, P = 0.035) and OS (HR 0.27, 95% CI 0.08-0.86, P = 0.027) compared with mastectomy. After IPTW adjustment, the results of 5-year LRR, DM, DFS remained the same, which were 10.0% vs 7.3% (P = 0.598), 11.7% vs 19.0% (P = 0.341), 78.6% vs 79.1% (P = 0.908) for BCS and mastectomy groups, respectively. The 5-year BCSS and OS were better in the BCS group than in the mastectomy group, but the difference was no longer statistically significant (BCSS: 99.7% vs. 90.8%, <i>P</i> = 0.095 and OS: 99.7% vs. 90.6%, <i>P</i> = 0.083). <h3>Conclusion</h3> Locoregional and distant control and DFS are comparable with BCS and mastectomy, but BCSS and OS may be better with BCS. Thus, BCS is a safe treatment option for selected breast cancer patients after NACT.

Real-world outcomes for Chinese breast cancer patients with tumor location of central and nipple portion.

BackgroundThe association between tumor location and breast cancer prognosis has been controversial. We sought to explore the relationship between tumors located in central and nipple portion (TCNP) and Chinese breast cancer.Patients and methodsA total of 1,427 breast cancer patients were recruited. There were 328 cases of TCNP and 1,099 cases of tumors in the breast peripheral quadrant (TBPQ). The chi-square test was used to compare different variables between TCNP and TBPQ groups. A one-to-one propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of TCNP and TBPQ groups. Kaplan–Meier curves were used for survival analysis of disease-free survival (DFS), breast cancer-specific survival (BCSS) and overall survival (OS). The Cox proportional hazards regression model was applied to identify prognostic risk factors.ResultsThe median follow-up time was 58 months. Compared to TBPQ, TCNP patients had significantly larger tumor size, more frequent metastasis to lymph nodes (LN) and more proportions of TNM stage II–III. DFS, OS and BCSS rates were markedly lower in the TCNP group as compared to the TBPQ group before and after PSM (all p < 0.05). Multivariate Cox analysis showed that TCNP was an independent prognostic factor for breast cancer. Subgroup analysis indicated that for breast molecular subtypes and TNM stage II-III breast cancer, TCNP were related to worse prognosis. Multivariate logistic regression revealed that TCNP was an independent contributing factor for LN metastasis.ConclusionIn Chinese breast cancer, compared to TBPQ, TCNP is associated with more LN metastasis and poorer prognosis.

Axillary lymph node dissection plus radiotherapy may be an optimal strategy for patients with occult breast cancer

BackgroundBecause of the rarity of occult breast cancer (OBC) and limited experience in OBC treatment, the optimal treatment strategy is unknown. This study aimed to compare the efficacy of axillary lymph node dissection (ALND) plus radiotherapy with that of mastectomy plus ALND in patients with OBC. MethodsRelevant clinical data between January 2004 and December 2015 were retrospectively collected from the Surveillance, Epidemiology, and End Results database. The clinical characteristics and prognoses of patients who underwent ALND plus radiotherapy or mastectomy plus ALND were compared before and after propensity score matching. ResultsOverall, 569 eligible patients with OBC were included in this study. Of these, 247 patients underwent ALND plus radiotherapy and 322 underwent mastectomy plus ALND. The 5-year overall survival (OS) rates in the ALND plus radiotherapy group and the mastectomy plus ALND group were 89.2% and 80.6%, respectively; and the corresponding 5-year breast cancer-specific survival (BCSS) rates were 95.2% and 93.0%, respectively. After propensity score matching, the OS in the ALND plus radiotherapy group was significantly better than that in the mastectomy plus ALND group. In addition, further subgroup analyses revealed that ALND plus radiotherapy prolonged OS in the pN3 subgroup. Among patients receiving adjuvant chemotherapy, those who underwent ALND plus radiotherapy had better BCSS and OS than those who underwent mastectomy plus ALND. ConclusionsALND plus radiotherapy could improve the OS of patients with OBC, especially those with pN3 disease and those receiving chemotherapy. ALND combined with radiotherapy is the optimal treatment strategy for patients with imaging-negative OBC.

Intraoperative radiotherapy versus no radiotherapy for early stage low-risk breast cancer patients undergoing breast-conserving surgery: a propensity score matching study based on the SEER database.

To compare the effect of intraoperative radiotherapy (IORT) and no radiotherapy in early stage low-risk breast cancer patients undergoing breast-conserving surgery. According to the criteria recommended by ASTRO for patients eligible for IORT, we retrospectively selected women with early stage low-risk breast cancer who underwent breast-conserving surgery from 2010 to 2019 from the SEER database. Propensity score matching was used to balance the differences in baseline characteristics. The Kaplan-Meier method was used to calculate the overall survival (OS) and breast cancer-specific survival (BCSS) of patients, and the log-rank test was used to compare the differences. A total of 20,245 patients were included in the analysis, including 1738 in the IORT group and 18,507 in the no radiotherapy group, with a median follow-up of 41months. Before matching, the 5-year OS rates of the IORT group and the no radiotherapy group were 95.5% and 85.7% (p < 0.001), respectively, and the 5-year BCSS rates of the two groups were 99.6% and 98.3% (p < 0.001), respectively. After matching, the 5-year OS rates were 95.6% and 90.3% (p < 0.001) in the IORT group and the no radiotherapy group, respectively, and the 5-year BCSS rates were 99.5% and 99.1% (p = 0.028), respectively. Cox multivariate analysis of the original data showed that radiotherapy was an independent prognostic factor for both OS and BCSS (p < 0.05). For patients aged 50years or older with early stage low-risk breast cancer, IORT may be a better option, with improved BCSS compared to the elimination of radiotherapy. The study could not draw conclusions on OS, because underlying diseases may be unevenly distributed between the two groups.

Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women.

Postoperative complications may activate prometastatic systemic pathways through tissue damage, wound healing, infection, and inflammation. Postoperative complications are associated with inferior survival in several types of cancer. The aim was to determine the association between postoperative complications and survival in breast cancer. This population-based cohort included women operated for T1-3 N0-3 M0 invasive breast cancer in Sweden from 2008 to 2017. Only major surgical postoperative complications leading to readmission and/or reoperation within 30 days were considered. Main outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Prospectively collected nationwide register data were used. Multivariable Cox models were adjusted for clinical and socioeconomic confounders and co-morbidity. Among 57 152 women, major surgical postoperative complications were registered for 1854 patients. Median follow-up was 6.22 (0.09-11.70) years. Overall, 9163 patients died, and 3472 died from breast cancer. Major surgical postoperative complications were more common after mastectomy with or without immediate reconstruction (7.3 and 4.3 per cent respectively) than after breast-conserving surgery (2.3 per cent). Unadjusted 5-year OS and BCSS rates were 82.6 (95 per cent c.i. 80.8 to 84.5) and 92.1 (90.8 to 93.5) per cent respectively for women with a major surgical postoperative complication, and 88.8 (88.6 to 89.1) and 95.0 (94.8 to 95.2) per cent for those without a complication (P < 0.001). After adjustment, all-cause and breast cancer mortality rates remained higher after a major surgical postoperative complication (OS: HR 1.32, 95 per cent c.i. 1.15 to 1.51; BCSS: HR 1.31, 1.04 to 1.65). After stratification for type of breast surgery, this association remained significant only for women who had mastectomy without reconstruction (OS: HR 1.41, 1.20 to 1.66; BCSS: HR 1.36, 1.03 to 1.79). Major surgical postoperative complications are associated with inferior survival, especially after mastectomy. These results underline the importance of surgical de-escalation.

Prognosis comparison between intraoperative radiotherapy and whole-breast external beam radiotherapy for T1-2 stage breast cancer without lymph node metastasis treated with breast-conserving surgery: A case-control study after propensity score matching.

BackgroundExternal beam radiotherapy (EBRT), an adjuvant to breast-conserving surgery (BCS), requires a long treatment period, is costly, and is associated with numerous complications. Large sample studies with long follow-up periods are lacking regarding whether intraoperative radiotherapy (IORT), an emerging radiotherapy modality, can replace EBRT for patients with T1–2 early stage breast cancer without lymph node metastasis treated with BCS.MethodsWe identified 270,842 patients with T1-2N0M0 breast cancer from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. A total of 10,992 patients were matched by propensity score matching (PSM). According to the radiotherapy method, the patients were divided into the IORT and EBRT groups. Overall survival (OS) and breast cancer-specific survival (BCSS) rates were analyzed and compared between the IORT and EBRT groups by Kaplan–Meier analysis. Bilateral P < 0.05 was considered to indicate significance.ResultsAfter PSM, the survival analysis showed no significant differences in OS or BCSS rates between the IORT and EBRT groups. In the subgroup analysis, the IORT population diagnosed from 2010 to 2013 (HRs = 0.675, 95% CI 0.467–0.976, P = 0.037) or with T2 stage (HRs = 0.449, 95% CI 0.261–0.772, P = 0.004) had better OS rates, but in the overall population, the OS and BCSS rates were better in patients with T1 stage than in patients with T2 stage (P < 0.0001), and the proportion of chemotherapy was significantly higher in T2 stage than in T1 stage. Patients who had EBRT with unknown estrogen receptor had better OS rates (HRs = 3.392, 95% CI 1.368–8.407, P = 0.008). In addition, the IORT group had better BCSS rates for married (HRs = 0.403, 95% CI 0.184–0.881, P = 0.023), grade III (HRs = 0.405, 95% CI 0.173–0.952, P = 0.038), and chemotherapy-receiving (HRs = 0.327, 95% CI 0.116–0.917, P = 0.034) patients with breast cancer compared to the EBRT group.ConclusionIntraoperative radiotherapy results of non-inferior OS and BCSS rates, compared to those of EBRT, in patients with early stage breast cancer without lymph node metastasis treated with BCS, and IORT may provide substantial benefits to patients as an effective alternative to standard treatment. This finding provides new insights into radiotherapy strategies for early stage breast cancer.

Evaluation of Adjuvant Treatments for Adenoid Cystic Carcinoma of the Breast: A Population-Based, Propensity Score Matched Cohort Study from the SEER Database.

Adenoid cystic carcinoma (ACC) is an extremely rare type of breast cancer. The role of adjuvant treatments for ACC remains controversial. Patients with a histology-confirmed diagnosis of ACC of the breast were identified based on the SEER (Surveillance, Epidemiology and End Results) database. Propensity score matching (PSM) was performed to balance the baseline characteristics. The Kaplan–Meier method and Cox regression models were performed to determine the impact of the adjuvant chemotherapy (CT) and radiotherapy (RT) associated with breast cancer-specific survival (BCSS) and overall survival (OS). A total of 1036 patients with ACC of the breast were included. After a median follow-up of 11.3 years, the 10-year OS and BCSS rate was 76.2% and 92.6%, respectively. After PSM, adjuvant CT converted into neither OS (Log-rank p = 1.000) nor BCSS (Log-rank p = 0.900) benefits in patients with ACC of the breast. Adjuvant RT also did not improve OS (Log-rank p = 0.060) and BCSS (Log-rank p = 0.400). According to the univariate stratified analysis, adjuvant RT was favorable for OS in patients who underwent breast-conserving surgery (HR 0.66, 95% CI 0.45, 0.99, p = 0.042). From the multivariate analysis, histology grade and nodal status were independent prognostic factors for both OS and BCSS. In conclusion, ACC of the breast presented a favorable prognosis. Adjuvant treatment, especially adjuvant CT, might not be essential for patients with this disease.

Survival benefit from axillary surgery in patients aged 70 years or older with clinically node-negative breast cancer: A population-based propensity-score matched analysis

BackgroundOlder patients with breast cancer have good prognosis and most die from diseases other than breast cancer. Previous studies suggested that the surgical extent in older patients could be reduced. We aimed to compare survival outcomes in patients aged ≥70 years with clinically node-negative breast cancer, based on whether axillary surgery was performed. MethodsA total of 2,995 patients with breast cancer aged ≥70 years who underwent breast surgery were included in the Korean Breast Cancer Registry. Patients were classified into two groups according to the performance of axillary surgery. We used propensity score matching for demographic and treatment factors to minimize selection bias. We compared the 5-year overall survival (OS) and breast cancer-specific survival (BCSS). ResultsAmong 708 patients after 3:1 propensity score matching, 531 underwent breast surgery with axillary surgery and 177 underwent breast surgery alone. Of all patients, 51.7% had T1 stage, and 73.2% underwent mastectomy. Approximately 31.2% of patients received chemotherapy. Among patients who did not undergo axillary surgery, the 5-year OS and BCSS rates were 85.2% and 96.7%, respectively. The hazard ratio of axillary surgery for OS was 0.943 (95% confidence interval 0.652–1.365, p = 0.757), indicating no significant difference between two groups. ConclusionsOur study demonstrates that axillary surgery in a matched cohort of older patients with breast cancer and clinically negative nodes does not provide a survival benefit compared to patients undergoing breast surgery alone. These findings suggest that axillary surgery may be safely omitted in a select group of patients aged ≥70 years with clinically node-negative cancer. Further studies are needed to identify potential candidates for omitting axillary surgery.