Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor-Positive Breast Cancer: A National Cancer Data Base Study

Akiko Chiba, Tanya L. Hoskin, Courtney N. Heins, Kelly K. Hunt, Elizabeth B Habermann, Judy C Boughey

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17 Citations (Scopus)

Abstract

Background: The American College of Surgeons Oncology Group Z1031 trial demonstrated that neoadjuvant endocrine therapy (NET) increased breast-conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor-positive breast cancer. We evaluated national trends in NET use in relation to the conduct of the Z1031 trial and the impact of NET on the rates of BCS. Methods: Using the National Cancer Data Base (NCDB), we identified all cT2–4c hormone receptor (HR)-positive breast cancer patients age ≥50 years from 2004 to 2012. The time intervals of pre-Z1031 (2004–2006), during Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined, and adjusted analyses were performed using multivariable logistic regression. Results: Of 77,272 patients, 2294 (3.0 %) received NET. Clinical T-stage distribution was 66,885 (86.6 %) for cT2, 7318 (9.5 %) for cT3, and 3069 (4.0 %) for cT4a–c. A small but statistically significant increase in NET use was noted, from 2.7 % pre-Z1031 to 3.2 % post-Z1031; the adjusted odds ratio (OR) for NET was 1.28 [95 % confidence interval (CI) 1.13–1.45; p < 0.001] for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage, increasing from 1.8 % pre-Z1031 to 2.4 % post-Z1031 in cT2 patients (p < 0.001) and from 6.3 % pre-Z1031 to 7.4 % post-Z1031 in cT3 patients (p = 0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4 vs. 43.9 %; p = 0.02) with an adjusted OR of 1.60 (95 % CI 1.46–1.75; p < 0.001). Conclusions: NET use has increased slowly since the Z1031 trial; however, overall use remains low. NET significantly increased the rates of BCS in patients with HR-positive clinical T2–4c breast cancer. Clinicians should consider NET use for patients with HR-positive breast cancer interested in BCS.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Sep 23 2016

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Neoadjuvant Therapy
Breast
Databases
Hormones
Breast Neoplasms
Segmental Mastectomy
Neoplasms
Odds Ratio
Confidence Intervals
Estrogen Receptors
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{c38cd7d9be374bf79dee910d3352a74d,
title = "Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor-Positive Breast Cancer: A National Cancer Data Base Study",
abstract = "Background: The American College of Surgeons Oncology Group Z1031 trial demonstrated that neoadjuvant endocrine therapy (NET) increased breast-conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor-positive breast cancer. We evaluated national trends in NET use in relation to the conduct of the Z1031 trial and the impact of NET on the rates of BCS. Methods: Using the National Cancer Data Base (NCDB), we identified all cT2–4c hormone receptor (HR)-positive breast cancer patients age ≥50 years from 2004 to 2012. The time intervals of pre-Z1031 (2004–2006), during Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined, and adjusted analyses were performed using multivariable logistic regression. Results: Of 77,272 patients, 2294 (3.0 {\%}) received NET. Clinical T-stage distribution was 66,885 (86.6 {\%}) for cT2, 7318 (9.5 {\%}) for cT3, and 3069 (4.0 {\%}) for cT4a–c. A small but statistically significant increase in NET use was noted, from 2.7 {\%} pre-Z1031 to 3.2 {\%} post-Z1031; the adjusted odds ratio (OR) for NET was 1.28 [95 {\%} confidence interval (CI) 1.13–1.45; p < 0.001] for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage, increasing from 1.8 {\%} pre-Z1031 to 2.4 {\%} post-Z1031 in cT2 patients (p < 0.001) and from 6.3 {\%} pre-Z1031 to 7.4 {\%} post-Z1031 in cT3 patients (p = 0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4 vs. 43.9 {\%}; p = 0.02) with an adjusted OR of 1.60 (95 {\%} CI 1.46–1.75; p < 0.001). Conclusions: NET use has increased slowly since the Z1031 trial; however, overall use remains low. NET significantly increased the rates of BCS in patients with HR-positive clinical T2–4c breast cancer. Clinicians should consider NET use for patients with HR-positive breast cancer interested in BCS.",
author = "Akiko Chiba and Hoskin, {Tanya L.} and Heins, {Courtney N.} and Hunt, {Kelly K.} and Habermann, {Elizabeth B} and Boughey, {Judy C}",
year = "2016",
month = "9",
day = "23",
doi = "10.1245/s10434-016-5585-5",
language = "English (US)",
pages = "1--7",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor-Positive Breast Cancer

T2 - A National Cancer Data Base Study

AU - Chiba, Akiko

AU - Hoskin, Tanya L.

AU - Heins, Courtney N.

AU - Hunt, Kelly K.

AU - Habermann, Elizabeth B

AU - Boughey, Judy C

PY - 2016/9/23

Y1 - 2016/9/23

N2 - Background: The American College of Surgeons Oncology Group Z1031 trial demonstrated that neoadjuvant endocrine therapy (NET) increased breast-conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor-positive breast cancer. We evaluated national trends in NET use in relation to the conduct of the Z1031 trial and the impact of NET on the rates of BCS. Methods: Using the National Cancer Data Base (NCDB), we identified all cT2–4c hormone receptor (HR)-positive breast cancer patients age ≥50 years from 2004 to 2012. The time intervals of pre-Z1031 (2004–2006), during Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined, and adjusted analyses were performed using multivariable logistic regression. Results: Of 77,272 patients, 2294 (3.0 %) received NET. Clinical T-stage distribution was 66,885 (86.6 %) for cT2, 7318 (9.5 %) for cT3, and 3069 (4.0 %) for cT4a–c. A small but statistically significant increase in NET use was noted, from 2.7 % pre-Z1031 to 3.2 % post-Z1031; the adjusted odds ratio (OR) for NET was 1.28 [95 % confidence interval (CI) 1.13–1.45; p < 0.001] for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage, increasing from 1.8 % pre-Z1031 to 2.4 % post-Z1031 in cT2 patients (p < 0.001) and from 6.3 % pre-Z1031 to 7.4 % post-Z1031 in cT3 patients (p = 0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4 vs. 43.9 %; p = 0.02) with an adjusted OR of 1.60 (95 % CI 1.46–1.75; p < 0.001). Conclusions: NET use has increased slowly since the Z1031 trial; however, overall use remains low. NET significantly increased the rates of BCS in patients with HR-positive clinical T2–4c breast cancer. Clinicians should consider NET use for patients with HR-positive breast cancer interested in BCS.

AB - Background: The American College of Surgeons Oncology Group Z1031 trial demonstrated that neoadjuvant endocrine therapy (NET) increased breast-conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor-positive breast cancer. We evaluated national trends in NET use in relation to the conduct of the Z1031 trial and the impact of NET on the rates of BCS. Methods: Using the National Cancer Data Base (NCDB), we identified all cT2–4c hormone receptor (HR)-positive breast cancer patients age ≥50 years from 2004 to 2012. The time intervals of pre-Z1031 (2004–2006), during Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined, and adjusted analyses were performed using multivariable logistic regression. Results: Of 77,272 patients, 2294 (3.0 %) received NET. Clinical T-stage distribution was 66,885 (86.6 %) for cT2, 7318 (9.5 %) for cT3, and 3069 (4.0 %) for cT4a–c. A small but statistically significant increase in NET use was noted, from 2.7 % pre-Z1031 to 3.2 % post-Z1031; the adjusted odds ratio (OR) for NET was 1.28 [95 % confidence interval (CI) 1.13–1.45; p < 0.001] for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage, increasing from 1.8 % pre-Z1031 to 2.4 % post-Z1031 in cT2 patients (p < 0.001) and from 6.3 % pre-Z1031 to 7.4 % post-Z1031 in cT3 patients (p = 0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4 vs. 43.9 %; p = 0.02) with an adjusted OR of 1.60 (95 % CI 1.46–1.75; p < 0.001). Conclusions: NET use has increased slowly since the Z1031 trial; however, overall use remains low. NET significantly increased the rates of BCS in patients with HR-positive clinical T2–4c breast cancer. Clinicians should consider NET use for patients with HR-positive breast cancer interested in BCS.

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DO - 10.1245/s10434-016-5585-5

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

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