Background: Surgery is very common for patients diagnosed with breast cancer. Its impact on survival depends on diagnostic, patient, tumor-related, and other-treatment factors. Moreover, time to surgery from the date of diagnosis is also a critical factor affecting outcome. Objective: In this study we investigated the impact of surgery on survival in breast cancer patients using two methods: (1) multivariate regression; and (2) propensity score matching. For the patients undergoing surgical intervention, we aimed to identify the optimum time from diagnosis to surgery. Methods: The study population was taken from the National Cancer Database over the years 2004 through 2014. Of 2,211,245 patients, 99.1% were female, 0.9% male, 85% non-Hispanic white, 10.5% black, 0.7% Hispanic, and 14.5% other races. Mean age of the patient population was 60.0 ± 13.4 years (range: 18–90). The majority of the patients (92.9%) underwent a surgical procedure. Results: Overall, the patients who did not undergo surgery were 6.7 times more likely to die within the study time period (95% confidence interval [CI]: 6.7–6.8, p<0.001) than those who did. However, after adjusting for patients' demographics, tumor-related factors, cancer stages, and combination of other treatments, the risk for dying of patients without surgery was 2.3 times higher (hazard ratio [HR]: 2.3, 95% CI: 2.3–2.4, p<0.001). In the propensity-matched cohort of 51,630 patients that was divided equally into two groups — those who underwent surgery and those who did not — the risk of mortality remained 2.4 times higher for patients without surgery (HR: 2.4, 95% CI: 2.3–2.4, p<0.001). Regarding time to surgery from the date of diagnosis, patient survival was best for the patients whose time to surgery ranged from 31 to 60 days. The next best timeframe was 61 to 90 days, followed by 30 days or fewer, then 91 to 120 days, and finally 120 and more days (p<0.001). Conclusion: Using two different statistical methods, surgery is clearly an independent predictor of survival for patients with breast cancer. After matching for other factors, patients not having surgery were more than twice as likely to die as their surgical counterparts. Time to surgery from the date of diagonosis confirmed ealier findings that surgery is most benificial within 2–3 months from the date of diangosis. These findings can provide clinical guidance to clinicians and patients for planning treatment. Citation Format: Singh M, Konduri SD, Bobustuc GC, Rovin RA, Kassam AB. Impact of surgery and time to surgery on breast cancer survival in the United States, 2004–2014 (N=2,211,245) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-28.
Background: For patients diagnosed with breast cancer treatment plans are usually determined by biomarkers such as ER, PR and HER2, the absence or presence of which determines molecular subtype of the tumor (luminal A, luminal B, triple-negative, and HER2-enriched). However, it is unclear to what extent each treatment plan contributes to overall survival across these four molecular types of breast cancer (as determined by the presence or combination of biomarkers). Objective: Assuming inherent heterogeneity among breast cancer patients, we sought to determine the benefit of any one or combination of treatment methods among surgery, chemotherapy, radiation, immunotherapy, and hormonal therapy and whether differences exist among various subgroups for predicting mortality risk. Methods: A total of 827,888 patients diagnosed with breast cancer from the National Cancer Database were analyzed. The patient population was 99.1% female, 0.9% male, 75.5% white, 11.2% black, 0.8% Hispanic, and 12.5% other races. Most of the patients (97.1%) were diagnosed with invasive breast cancer; the remaining 2.9% were diagnosed with in situ and/or carcinoma in situ. For molecular subtypes, the distribution of patients was 72.7% with luminal A, 10.4% luminal B, 4.7% HER2-enriched and 12.2% triple-negative. Results: Overall, patients who did not receive treatment were 6.9 times more likely to die (95% confidence interval [CI]: 6.7–7.0) than those who did. Within molecular subtypes, hazards ratios [HR] were for dying without treatment were7.0 (95% CI: 6.8–7.1) for luminal A, 7.8 (95% CI: 7.3–8.3) for luminal B, 6.9 (95% CI: 6.6–7.2) for triple-negative, and 8.9 (95% CI: 8.2–9.7) for HER2-enriched tumor. Overall survival was best for luminal A, followed by luminal B, HER2-enriched and triple-negative (p<0.001). Multivariate Cox regression showed that the five most significant factors predicting mortality for luminal A were surgical treatment (HR: 0.4, p<0.001), patient age (HR: 1.1 one year increment , p<0.001), cancer stage (HR: 1.2, 2.1, 4.1, and 7.4 for stage I, II, III, and IV [all vs stage 0], respectively, p<0.001), Charlson/Deyo score (HR: 1.4, 2.1, and 2.9 for score 1, 2, and ≥3 [all vs score 0], respectively, p<0.001), and tumor grade (HR:0.8, 0.5, and 0.4 for poorly, moderately, and well-differentiated tumors [all vs undifferentiated], respectively). For luminal B, HER2-enriched molecular types, and for triple negative chemotherapy (HR: 0.5, 0.6, 0.5, respectively) replaced grade differentiation as one of the top five predictors. Conclusion: Despite recent suggestions of over diagnoses and unnecessary treatment for certain types of tumor, this retrospective study suggested that treatment remains highly beneficial for breast cancer patients. Among treatments, surgery remains a strong predictor of survival across the board; however, for luminal B, HER2-enriched, and for triple negative subtype chemotherapy along with surgery provides additional survival benefit. Overall survival was better for luminal A, followed by luminal B, HER2 and triple negative breast cancer. These results can provide guidance for clinicians as well as for patients. Citation Format: Konduri SD, Singh M, Bobustuc GC, Rovin RA, Kassam AB. Treatment across the four molecular types of breast cancer: Insight from the national cancer database, 2010–2014 (N=827,888) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-35.
Background/Objective: Biomarkers such as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2neu) are associated with the survival and recurrence of invasive breast cancer (IBC). Presence of these markers often helps to dictate treatment plans. The purpose of this study is to identify the predictors of overall survival (OS) and disease-free survival (DFS) for women diagnosed with IBC. In this study, we compared OS and DSF in the following five categories based on biomarker expression: triple-negative (TN), triple-positive (TP), HER2neu-positive, Luminal A (LA) and Luminal B (LB). Method: We retrospectively examined 6,231 records of women diagnosed with IBC from 2006 through 2015 within the Aurora Health Care system. The majority of the women were white (90.8%) and non-Hispanic (97.4%). The women in this study were categorized in the age groups: 20-39 (4.9%), 40-59 (42.8%), 50-69 (40.7%) and 70+ years (11.6%). We used descriptive statistics for all category and numeric variables. Kaplan-Meier curve was used to compare OS and DFS in the five categories. Cox proportional hazards regression was used to identify the significant predictors of OS and DFS. We used alpha of 0.05 for all statistical tests and all statistical analysis was done using SAS 9.4. Results: OS was 86.39% and the DFS rate was 84.43%. In multivariate analysis significant predictors of OS included age (HR=1.94 for 60-69 vs 20-39 p=0.001 and HR=5.3 for 70+ vs 20-39 p< 0.001), race (HR=0.57, p=0.043 for white vs other), ethnicity (HR=0.34, p=0.032), HER2neu expression (HR=0.58, p <0.001), size of the tumor (HR=1.001 p=0.011), grade differentiation (HR=0.62 p < 0.001) and cancer stages (HR of 1.17, 4.8, 15.2 for II, III and IV vs I, p <0.001). Furthermore treatments such as surgery (HR=0.64, p< 0.001), radiation (HR=0.64, p <0.001), chemotherapy (HR=0.63, p <0.001) and hormonal therapy (HR=0.48, p <0.001) showed significantly improved OS in the patients. Similarly significant predictors of DFS included, age (HR=1.8, p <0.001 for 70+ vs 20-39); PR (HR=0.70, p=0.003), HER2neu (HR=0.60, p <0.001) tumor size (HR=1.001, p=0.002), cancer stage (HR=2.7, 9.2, 25.5 for II, III, IV vs I, p<0.001); differentiation of the tumor (HR=0.75, p=0.002, moderate differentiation; well differentiated, HR=0.50, p <0.001). Moreover, the treatments such as surgery (HR=0.42, p <001) radiation, chemotherapy and hormonal therapy (HR=0.58, 0.62, 0.51 p <0.001) significantly increased DFS. Furthermore OS was better for women diagnosed with TP, LA, HER2, LB types compared to women with TN (p<0.001). Similarly the probability for DFS was higher for TP also was higher compared to the probabilities all the other categories (LA, LB, HER2 and TN p <0.05). LA had better DFS then LB, HER2 and TN. LB and HER2 had better DFS than TN (p<0.05). Conclusion: This large study suggests that treatment based on biomarker expression (ER, PR and HER2/Neu) has improved OS and DFS for women with IBC. Increase in tumor size, cancer stage and poor differentiation of the tumor had adverse effect on both OS and DFS. Treatment modalities such as surgery, radiation, chemotherapy and hormonal therapies significantly improved both OS and DFS. Citation Format: Singh M, Konduri SD, Bobustuc GC, Rovin RA. Predictors of overall survival and disease-free survival for women diagnosed with invasive breast cancer: A large single-center study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-17.
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