Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening

Abstract

The aim of this study is to determine the survival of patients with breast cancer treated with adjuvant chemotherapy (ACh) after the diagnosis by screening, taking comorbidity into account. This multicenter cohort study examined a population of patients taking part in four national screening programs for the early detection of breast cancer (localized or locally advanced), during the period 2000‐2008. Of the 1248 cancers detected, 266 were prevalent (21.3%), 633 were incident (50.7%), and 349 were interval (27.9%). No significant differences were detected between the three groups in terms of the distribution of comorbidity according to the CCI. After a median follow‐up of 102 months, 22.1% of the patients with interval cancer had died. The corresponding figures for the incident and prevalent cancers were 10.4% and 7.9%, respectively (P < .001). The adjusted Cox regression analysis by the stage, CCI and group revealed no differences in the risk of recurrence between the different groups according to the ACh performed. However, there were significant differences in the overall survival; for the interval cancer group without ACh, the risk of death was higher (Hazard ratio: 2.5 [1.0‐6.2]) than for the other two groups. However, for the prevalent and incident groups that did not receive ACh, there was no greater risk of death. This study shows that adjuvant chemotherapy seems to benefit patients with interval breast cancer, who have a poorer prognosis than those with prevalent or incident cancer. However, the role of ACh is unclear with respect to prevalent and incident cancers when comorbidity is taken into account.

Impact of HIV infection on survival among women with stage I‐III breast cancer: Results from the South African breast cancer and HIV outcomes study

“…We compared the distribution of the categorical and continuous vari- Ki67 score (<20% vs ≥20%) 21 and treatment received (surgery and chemotherapy vs surgery/no chemotherapy vs chemotherapy/no surgery vs no surgery or chemotherapy) 22,23 ]. Additional variables showing an association with OS in the univariate analysis with a significance of P < .1 and not part of the a priori set of covariates were also included in the multivariable model; these included ethnicity, highest level of education achieved and body mass index (BMI).…”

“…We then constructed a multivariable Cox proportional hazards model to investigate the effect of HIV status on OS, while adjusting for the effects of other demographic and clinical characteristics. In that model, we included covariates known a priori to impact BC survival [age, ECOG performance status at diagnosis, 19 clinical stage (I and II vs III), 7 receptor subtype (ER+/PR+/HER2− and ER+/PR+/HER2+ vs ER−/PR−/HER2+ and ER−/PR−/HER2−), 20 Ki67 score (<20% vs ≥20%) 21 and treatment received (surgery and chemotherapy vs surgery/no chemotherapy vs chemotherapy/no surgery vs no surgery or chemotherapy) 22,23 ]. Additional variables showing an association with OS in the univariate analysis with a significance of P < .1 and not part of the a priori set of covariates were also included in the multivariable model; these included ethnicity, highest level of education achieved and body mass index (BMI).…”