Population-based study on cancer subtypes, guideline-concordant adjuvant therapy, and survival among women with Stage I-III breast cancer

Abstract

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 guidelineconcordant 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 guidelineconcordant 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 HR1/HER2- followed by HR-/HER2- (14.4%), and 78.6% received guideline-concordant AST. Compared with patients with the HR1/HER21 subtype, women with other subtypes were more likely to be guideline-concordant after adjusting for sociodemographic and clinical variables. Women with the HR-/HER21 or HR-/HER2- subtype had a higher risk of any-cause and breast cancer-specific death than those with the HR1/HER21 subtype. Those who did not receive AST had an additional adjusted hazard of 0.0191 (P5.0001) in overall survival and 0.0126 (P5.0011) in cause-specific survival compared with those who received AST. Conclusions: Most patients received guideline-concordant AST, except for those with the HR1/HER21 subtype. Patients receiving guideline-adherent adjuvant therapy had better survival outcomes across all breast cancer subtypes.