Validation of a Risk Score to Enhance Prognostic Stratification of Breast Cancer Patients Using the National Cancer Data Base (NCDB)

1033 Background: The Cancer and Leukemia Group B (CALGB) 9343 trial published in 2004 showed no overall survival benefit from radiation in patients >70 years old with estrogen receptor (ER) positive, pT1 tumors with the use of tamoxifen. We tested the hypothesis that the use of radiotherapy decreased in this group of patients following publication of the trial, utilizing the National Cancer Data Base. Methods: 34,853 breast cancer patients 70 years or older with pT1N0/NX, ER positive tumors who underwent a lumpectomy between 2004 and 2007 were studied. Chi-square tests and logistic regression models were used to determine trends and factors related to the use of radiation. Results: The use of radiation decreased from 70.6% in 2004 to 66.4% in 2005, 66.6% in 2006, and 67.2% in 2007 (p<0.001). The use of standard external beam radiation decreased from 58.8% in 2004 to 45.8% in 2007 while the use of accelerated partial breast radiation using brachytherapy (APBI) increased from 4.5% to 10.0%, IMRT radiation from 3.1% to 5.3%, and 3D conformal radiation from 3.7% to 5.7% (p<0.001). Patients between the ages of 86+ years old were less likely to undergo radiation than patients 70-75 years old (OR=0.12, 95% CI: 0.11-0.13). Asian Pacific Islanders were more likely to undergo radiation than whites (OR=1.39, 95% CI: 1.13-1.70). In community cancer programs, 67% patients received radiation, compared to 69.1% in comprehensive community programs and 65.5% in academic programs (p<0.001). The use of radiation varied by facility location; 73.5% of facilities located in the Midwest radiated these patients as opposed to 62.6% in the South. In patients who had no nodes examined, 37% underwent radiation as opposed to 74% who did have nodes examined (p<0.001). Likewise, 79.4% of patients who received hormone therapy underwent radiation as opposed to 54.6% of patients who did not receive hormonal therapy (p<0.001). Conclusions: The use of radiation therapy decreased only slightly and remained high in women with ER+ stage I breast cancer over the age of 70, despite findings from the CALGB 9343 study. However, there was a large shift in radiation modality over the study period in the older patients.

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Survival advantage associated with neoadjuvant chemotherapy compared to neoadjuvant hormonal therapy in postmenopausal women with hormone receptor positive breast cancer: A National Cancer Data Base study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12119 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12119-e12119

Author(s):

Alina Basnet ◽

Dongliang Wang ◽

Abirami Sivapiragasam

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Hormone Receptor ◽

National Cancer Data Base ◽

Breast Cancer Patients ◽

Cancer Data ◽

Hormone Receptor Positive ◽

Positive Breast Cancer

e12119 Background: Neoadjuvant endocrine therapy (NET) and neoadjuvant chemotherapy (NCT) are both considered effective strategies in postmenopausal, hormone receptor positive breast cancer patients. Small prospective studies show comparable response rates and breast conservation rates. Using National Cancer Data Base (NCDB) we report overall survival (OS) differences between these two strategies with subgroup analysis by Estrogen Receptor (ER), Progesterone Receptor (PgR) status. Methods: We extracted data on hormone receptor positive breast cancer patients without metastasis in women aged ≥ 50 from the NCDB registry (2004-2014). We excluded patients who did not receive adjuvant endocrine therapy after NCT and patients who received adjuvant chemotherapy after NET as this could affect OS. We calculated OS using Kaplan Meier analysis with hazard ratio (HR) from cox regression model. Subgroup analysis was performed by ER, PgR status. Results: Out of 2,246,279 patients, 30,348 patients met our inclusion criteria. 7836 received NET and 22512 received NCT. OS rate was 70.8% vs 81.7% at 5 yrs and 42.5% vs 62.1% at 9 yrs for NET and NCT respectively with adjusted hazard ratio (HR) of 1.818; 95% CI (1.657-1.996). OS outcome for ER+/PgR+ group was 72.3% vs 83.5% at 5 yrs and 43.5% vs 64% at 9 yrs for NET and NCT respectively with adjusted HR of 1.807; 95% CI (1.624-2.010). OS for ER+/pgR- group was 62.9% vs 76.8% at 5 yrs and 33.1% vs 54.2% at 9 yrs for NET and NCT respectively with adjusted HR of 1.890; 95% CI (1.549-2.306). Our analysis also revealed that 5591 T1 patients received neoadjuvant therapy among which 2541 received NET and 3050 received NCT. Conclusions: We find a significant survival advantage in patients treated with NCT as opposed to NET. All subgroups showed imporved OS with NCT compared with NET. Limitations that should be considered in this registry based study are: not accounting for Her-2 status, differences in surgical technique, duration and choices of adjuvant chemotherapy and radiotherapy options.

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The Impact of Post-Mastectomy Chest-Wall Radiation on Overall Survival for Intermediate-Risk Breast Cancer Patients: A National Cancer Data Base Analysis

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.06.678 ◽

2019 ◽

Vol 105 (1) ◽

pp. E27-E28

Author(s):

C. Jiang ◽

S.A. Patel ◽

C. Arciero ◽

T.M. Styblo ◽

T. Gillespie ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Patients ◽

National Cancer Data Base ◽

Intermediate Risk ◽

Breast Cancer Patients ◽

Cancer Data ◽

Base Analysis ◽

The Impact ◽

Risk Breast Cancer

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Utilization, trend and impact of neoadjuvant endocrine therapy compared to neoadjuvant chemotherapy in postmenopausal breast cancer patients: Analysis of the National Cancer Data Base.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.578 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 578-578

Author(s):

Alina Basnet ◽

Dongliang Wang ◽

Abirami Sivapiragasam

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

National Cancer Data Base ◽

Breast Cancer Patients ◽

Upward Trend ◽

Neoadjuvant Endocrine Therapy ◽

Cancer Data ◽

Net Use ◽

Prospective Trials

578 Background: Three small prospective trials that compared the efficacy of neoadjuvant endocrine therapy (NET) to neoadjuvant chemotherapy (NCT) showed no statistically significant difference. We report the differences in utilization of NET and NCT using National Cancer Data Base (NCDB) and their trend, response rates (RR) and breast conservation rates (BCR). Methods: A retrospective review of hormone receptor positive breast cancer patients ≥ 50 yrs without metastasis using NCDB was performed (2004-2014). Patients underwent NET or NCT prior to definitive surgery. Utilization pattern, practice trend, RR and BCR between NET and NCT was assessed using univariate and multivariate logistic analysis. Results: Out of 2,246,279 breast cancer patients reported in NCDB, 38,632 met our inclusion criteria. 9178 received NET and 29,454 received NCT. On multivariate analysis NET use was higher in academic vs community centers [Odds ratio (OR) 1.355, 95% CI 1.270-1.445], age >70 vs < 70 (OR 6.603, 95% CI 6.110-7.137) and high vs low Charlson Deyo comorbidity index (OR 1.817, 95% CI 1.548-2.133). NET use was lower in black vs white (OR 0.790, 95% CI 0.712- 0.875), tumors with higher vs lower grade (OR 0.153, 95% CI 0.138-0.169), higher vs lower T stage (OR 0.372, 95% CI 0.340-0.407), higher vs lower N stage (OR 0.274, 95% CI 0.243-0.310) and private vs no insurance (OR 0.600, 95% CI 0.509- 0.707), (all p<0.0001). A significant upward trend in utilization of NET was observed from year 2011 (25.9%) compared to before (22.2%), p<0.0001. RR was significantly higher for patients receiving NCT (90.5%) compared to NET (77.2%), with an [adjusted OR (aOR) 2.413; 95% CI 2.116-2.752], however the BCR was superior in the NET group (50.0%) compared to NCT group (31.1%) with (aOR 1.676; 95% CI 1.567-1.794). Conclusions: Our study is the first to compare NET and NCT utilization and their efficacy using NCDB database. Our results have shown striking differences in outcome among these two strategies as compared to other prospective trials. Despite high RR, more patients underwent mastectomy in the NCT group. We also see a steady upward trend in usage of NET from year 2011.

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