Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma

Abstract

Background Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer. Objective This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer. Methods Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging). Results T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61–90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05–1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17–1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13–1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging. Conclusion TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.

ASO Author Reflections: Does Prompt Breast-Conserving Surgery Matter?

“…This cohort study showed that delay in surgery is associated with disease progression among estrogen receptor (ER)-positive T1N0M0 ductal breast cancer patients who received breast-conserving surgery as their first definitive treatment; however, no such association was observed in ER-negative patients. 5 This study concluded that avoiding an excessive delay of surgery may reduce preoperative disease progression.…”

Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries

“…Furthermore, staging, histopathologic grading, tumor size, molecular subtype, and genomic testing results, unavailable in claims data, have predictive value for modeling time to treatment and selection of early-stage patients most likely to experience worsened survival with delay. 11 – 15 To address this, we excluded patients with claims that might reflect distant metastases, a method that despite having modest sensitivity (72.8%) has a greater than 94% negative predictive value. 45 Our analysis did not differentiate between types of additional encounters during the biopsy-to-surgery interval, such as imaging, diagnostic work-ups, or transfers of care, which are known to contribute to delays.…”

“… 3 – 6 Many contributors to the duration of the preoperative period of recently diagnosed patients are clinically appropriate and include surgical scheduling logistics requisite to case complexity, transfers of care, the seeking of second opinions, imaging, and treatment with neoadjuvant chemotherapy. 7 – 10 For patients with early-stage disease, however, surgical delays beyond 60 days have been associated with tumor and nodal upstaging, 11 , 12 as well as decreased survival, 4 , 12 – 15 with longer delays having a more pronounced adverse impact. Whereas numerous guidelines and quality measures have been established to define clinically appropriate intervals between breast cancer diagnosis and initiation of adjuvant chemotherapy, radiation, or endocrine therapy, guidelines specifying a recommended interval from diagnosis to surgery were lacking until 2020.…”

Nanomedicine-Based Delivery Strategies for Breast Cancer Treatment and Management

“…Our attention is focused on the final treatment option, pharmacological therapy, which is used to minimizetumor burden and prevent, control, or treat cancer spread. Hormonal therapy, which involves hormones or hormone-like substances, is frequently used in the treatment of breast cancer [ 18 ].Recent advances in molecular biology and immunotherapy have increased the inclusion of targeted medicines suited to the unique pathophysiology of several breast cancer subtypes. This technique often includes the use of a small chemical or monoclonal antibody to target a particular molecular pathway ( Figure 1 and Table 2 ), therefore preventing or controlling cancer proliferation, progression, dissemination, and/or treatment resistance.Trastuzumab (herceptin) is the most well-known targeted treatmentup to date.…”

“…This technique often includes the use of a small chemical or monoclonal antibody to target a particular molecular pathway ( Figure 1 and Table 2 ), therefore preventing or controlling cancer proliferation, progression, dissemination, and/or treatment resistance.Trastuzumab (herceptin) is the most well-known targeted treatmentup to date. It is a humanized anti-HER2 monoclonal antibody [ 18 ]. At the moment, adjuvant therapy treatment is mostly determined by the intrinsic subtype of breast cancer.…”