Risk for relapse and death after adjuvant chemotherapy associated with SNPs in patients with breast cancer - A retrospective study.

Objectives: The objective of this study was to assess the period of time elapsed between the date of biopsy and the date of surgery of patients with breast cancer (BC) assisted at the Mastology Service of HFL, from January 2014 to January 2017. We excluded from this analysis those patients with distant metastasis and the ones submitted to neoadjuvant chemotherapy. Introduction: Initial studies about the consequences on prognosis of the delay in diagnosis and treatment of BC tend to show that the longer the delay, the higher the disease staging at diagnosis; which, consequently, leads to lower survival rates. Methods: Retrospective study based on the analysis of medical records. We calculated the time elapsed between the date of biopsy of the malignant lesion and the date of the oncological surgery. The patients were divided in 3 groups regarding the time elapsed between biopsy and surgery: <60 days, 60 to 90 days and >90 days. Results: The mean waiting time for surgery was of 225.49 days. Only 2 patients (1.80%) waited less than 60 days. Seven patients (6.31%) were operated between 61 and 90 days, and the great majority of patients (102, in absolute numbers), waited for more than 90 days (90.89%). Discussion: Most studies associate the delay in diagnosis and BC treatment with lower survival rates. In a multivariate analysis, major delays to start the treatment were a significant risk factor for the reduction in survival. The delay in the surgical treatment of younger women (number of weeks between the date of diagnosis and date of definitive treatment) was assessed in a retrospective, case-control study published in 2013, which used data from the California Cancer Registry Database. In this study, the five-year survival of women treated with surgery who waited more than 6 weeks was 80%, in comparison to 90% among those whose delay was shorter than 2 weeks. Another retrospective study assessed the impact of the delay of the beginning of treatment after the biopsy confirmed BC. This analysis showed that the delay to begin the first treatment longer than or equal to 60 days was associated with worse specific survival rates. Gagliato et al showed the impact of the delay to start adjuvant chemotherapy in patients with BC in several stages, and with different tumor subtypes. The results showed worsened survival rates when the beginning of adjuvant chemotherapy was delayed in all of the study groups. Conclusion: Considering the data in this study and data from several others regarding the negative impact of delay in BC treatment, it is clear that efforts in all spheres of the government should be made so that the healing and survival rates can improve.

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Insurance status as a strong predictor of outcome in triple-negative breast cancer (TNBC): A multi-institutional retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1069 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1069-1069

Author(s):

Tithi Biswas ◽

Shreya Prasad ◽

Timothy Zagar ◽

Jimmy Efird ◽

Sarah E. James ◽

...

Keyword(s):

Breast Cancer ◽

Retrospective Study ◽

Adjuvant Chemotherapy ◽

White Women ◽

Early Stage ◽

Strong Predictor ◽

Private Insurance ◽

Disease Free Survival ◽

Early Stage Disease ◽

Chemotherapy Drugs

1069 Background: TNBC accounts for about 15-20% of all breast cancer. TNBC has particularly aggressive clinical course and accounts for a disproportionate number of breast cancer relapses and deaths in early stage disease. TNBC also have worse prognosis especially in African American (AA) women compared with white women. This retrospective study aims to investigate various clinical and demographic prognostic factors in TNBC. Methods: 476 TNBC patients who were treated at Eastern Carolina University and University of North Carolina, CH between 4/96 and 9/11 were included in this analysis. We collected data on age, race, grade, lymphovascular invasion (LVI), stage, treatments including surgery, chemotherapy, radiation, chemotherapy drugs, insurance type and year of treatment. Overall Survival (OS) was computed from the date of diagnosis to the date of death or last FU. For disease free survival (DFS), patients were scored if they failed either locally or distally. The Cox proportional-hazards regression model was used to compute hazard ratios. Results: The median age was 52 years (21-88 years) with median FU of 3.7 years. 49% women were white race followed by AA 223 (47%) and Hispanic or other race (5%). Stage (p<0.001), grade (p=0.02), surgery (p<0.0001), adjuvant chemotherapy (p=0.025), LVI (p=0.05) and type of insurance were significant predictor of OS. Similarly, stage (p<0.0001), surgery (p<0.0001), LVI (p=0.03) and insurance were significant predictors for DFS. On multivariate analysis, stage, surgery and adjuvant chemotherapy remained statistically significant predictors. Medicaid vs. Private Insurance also remained a significant detriment of survival (OS: HR=3.6, p<0.0001; DFS: HR=2.8, p<0.0001) as did having No Insurance for OS (HR=2.0, p=0.0074). Conclusions: To our knowledge, this is a largest retrospective study showing type of insurance to be a strong predictor of outcome in this very specific breast cancer subtype which remained significant after adjusting all other variables. Further insight is needed to determine the cause of this finding.

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Recurrence patterns among T1-2N0 triple-negative breast cancer patients following mastectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.93 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 93-93

Author(s):

Rebekah Young ◽

Kimberly Gergelis ◽

Shalom Kalnicki ◽

Jana Lauren Fox

Keyword(s):

Breast Cancer ◽

Retrospective Study ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Early Stage ◽

Breast Cancer Patients ◽

Single Institution ◽

Early Stage Disease ◽

Increased Risk

93 Background: Women with early-stage TN breast cancers are at increased risk for recurrence (RR) compared to other molecular subtypes, and are often treated with mastectomy without local adjuvant therapy. We wish to evaluate the RR for these women. Methods: In this single institution retrospective study, women with T1-2N0 TN breast cancer who underwent mastectomy between 2008-12 were identified from tumor registry. Adjuvant chemotherapy was allowed, but adjuvant radiotherapy (RT) was excluded. Of 3,000 cases reviewed, 52 women were identified. Median age was 58.5 (30–90). Lesions were high-grade (83%), and T1-2 (47%, 53%). 21 women (42%) had at least 1 risk factor. 5 women were BRCA+. Women underwent total mastectomy or modified radical mastectomy, and the majority (84%) had adjuvant chemotherapy. Results: At a median follow-up of 3.5 years (6-71 months), there were 8 recurrences (15.4%). 3 (5.8% of cohort) were locoregional (LR) only (2 chest wall (CW) and 1 ipsilateral axilla), 6 (11.5%) involved a concurrent LR and distant recurrence, and 2 (3.8%) were distant only. Median time to recurrence was 17.3 months. The isolated LR recurrences (LRR) were at 14, 15.6 and 15.1 months. Most women (41, 78.8%) were alive with NED. 3 were alive with disease, underdoing treatment, and 1 woman was disease free after treatment for CW recurrence. 8 patients (15.4%) are deceased, half from their cancer. On univariate analysis, there was no significant correlation (p>0.05) between age or high-risk features and RR (STATA v 11). Conclusions: T1-2N0 breast cancer patients are believed to have a low RR following mastectomy. TN disease, however, is more aggressive, and the question of irradiating early stage disease after mastectomy has arisen. A single institution, retrospective study found women with T1-2N0 TN disease fare better with BCT that includes RT, compared to mastectomy alone. Other studies have shown no statistical difference in RR between these 2 groups. We found an isolated LRR rate at 3.5 years of 5.8%. Follow-up and ultimately prospective data is needed to determine whether the isolated LRR warrants a change in treatment recommendations for this pt subset.

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