Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA.
Department of Internal Medicine, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
J Cancer Res Clin Oncol. 2021 Aug;147(8):2447-2458. doi: 10.1007/s00432-021-03525-6. Epub 2021 Jan 31.
Several studies have evaluated the role of delayed initiation of adjuvant chemotherapy (AC) in breast cancer (BC), but the results have remained controversial and an optimal time has not been defined. Our aim was to determine the effect of time to starting AC from the date of surgery on survival of BC patients, based on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, using data from the National Cancer Database (NCDB).
A total of 332,927 Stage I-III BC patients who received AC from 2010 to 2016 were analyzed. We included all ER, PR and HER2 statuses and excluded patients with stage 4 and stage 0 (DCIS) disease. The cohort was divided into five groups based on the time of initiating AC from the date of the most definitive surgery i.e., ≤ 30 days, 31-60 days, 61-90 days, 91-120 days and > 120 days. They were further divided into five subgroups based on the receptor status.
Hazard ratio (HR) estimates and Kaplan-Meier (KM) analysis shows that starting AC by 31-60 days shows the best survival outcome in all the subtypes, except in hormone positive/HER2 negative BC in which 31-60 days and 61-90 days have similar outcomes.
After surgery for BC, it takes around 4-6 weeks to begin AC and delay in initiating the same leads to poor outcomes. Our results are particularly significant in triple-negative breast cancer (TNBC), similar to prior studies showing a benefit to starting AC as early as possible after surgery.
已有多项研究评估了乳腺癌（BC）辅助化疗（AC）起始延迟的作用，但结果仍存在争议，且尚未确定最佳时间。我们旨在根据美国国家癌症数据库（NCDB）的数据，基于雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体 2（HER2）状态，确定从手术日期开始接受 AC 治疗的时间对 BC 患者生存的影响。
分析了 2010 年至 2016 年间接受 AC 治疗的 332927 例 I-III 期 BC 患者。我们纳入了所有 ER、PR 和 HER2 状态，并排除了 4 期和 0 期（DCIS）疾病患者。该队列根据从最明确手术日期开始启动 AC 的时间分为五组，即≤30 天、31-60 天、61-90 天、91-120 天和>120 天。然后根据受体状态将它们进一步分为五组。
风险比（HR）估计和 Kaplan-Meier（KM）分析显示，在所有亚组中，在 31-60 天内开始 AC 可获得最佳生存结果，除了激素阳性/HER2 阴性 BC 外，在这种情况下，31-60 天和 61-90 天的结果相似。
BC 手术后，大约需要 4-6 周的时间开始 AC，延迟启动会导致不良结果。我们的结果在三阴性乳腺癌（TNBC）中尤为显著，与先前研究表明手术后尽早开始 AC 有益的结果相似。
