Neoadjuvant Systemic Therapy Use for Younger Patients with Breast Cancer Treated in Different Types of Cancer Centers Across the United States

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• 作者：Jahan J. Mohiuddin ; MD^a ; Allison M. Deal ; MS^b ; ^c ; Lisa A. Carey ; MD^b ; ^d ; Jennifer L. Lund ; PhD^b ; ^e ; Brock R. Baker ; MD^a ; Timothy M. Zagar ; MD^b ; ^f ; Ellen L. Jones ; MD ; PhD^b ; ^f ; Lawrence B. Marks ; MD^b ; ^f ; Ronald C. Chen ; MD ; MPH^b ; ^f ; ^g ; ^{ronald_chen@med.unc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aRR ; adjusted risk ratio ; AUC ; area under the receiver operating curve ; NCCN ; National Comprehensive Cancer Network ; NCDB ; National Cancer Data Base ; pCR ; pathologic complete response
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：223
• 期：5
• 页码：717-728.e4
• 全文大小：610 K

文摘

Multiple clinical trials have shown that neoadjuvant systemic therapy has a benefit in women who are borderline lumpectomy candidates and in those with locally advanced breast cancers by reducing the mastectomy rate and making inoperable tumors operable. The study aim was to examine the patterns of neoadjuvant chemotherapy and endocrine therapy use among younger women in the United States treated at different types of cancer centers.

Study Design

Data from the National Cancer Data Base for 118,086 women younger than 65 years with clinical stage IIA (T2N0 only) to IIIC breast cancer. Following the National Comprehensive Cancer Network guideline categorization, patients were grouped into those who were borderline lumpectomy candidates (clinical stage IIA [T2N0 only], IIB, or IIIA [T3N1 only]) or those with locally advanced disease (clinical stage IIIA [T0-3N2 only], IIIB, or IIIC). The main outcome was the proportion of women who received neoadjuvant systemic therapy.

Results

Use of neoadjuvant chemotherapy ranged from 17% (stage IIA) to 79% (stage IIIB). Across almost all stage and receptor subtypes, the use was lower in community vs academic centers. On multivariable analysis, use of neoadjuvant chemotherapy was decreased in community vs academic centers (borderline lumpectomy candidates: adjusted risk ratio = 0.73; 95% CI, 0.69–0.77; locally advanced disease: adjusted risk ratio = 0.78; 95% CI, 0.74–0.83).

Conclusions

Use of guideline-concordant neoadjuvant chemotherapy is significantly higher among women treated at academic vs community centers in young and healthy women who do not commonly have contraindications to this treatment. Our study identified a potential disparity in cancer care by type of center where patients receive treatment.