Duffield Jaime A, Blanch Adam J, Esterman Adrian, Bochner Melissa A
Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Adelaide Medical School, The Unviersity of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2023 Apr;93(4):889-895. doi: 10.1111/ans.18367. Epub 2023 Mar 13.
Breast surgeons must maintain contemporary knowledge regarding appropriate referral for neoadjuvant chemotherapy (NACT) in breast cancer (BC) patients. To date, the greatest benefit is seen in stage II-III HER2-enriched and triple negative breast cancers (TNBC). This study is the first audit of use of NACT in Australia and New Zealand to stratify data by BC biological subtype.
Prospective data from 116,745 patients between 2010 and 2019 was provided by the Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit (BQA) of Breast Cancer Care. Annual rates of NACT use were determined and change across time analysed with fractional regression. Data from 2018 to 2019 were combined and stratified by biological subtype (LumA, LumB HER2-neg, LumB HER2-pos, HER2 enriched, TNBC, Other basal-like), and age (<50, 51-74, and ≥75 years) and compared using negative binomial regression.
The use of NACT increased annually (OR 1.26, P < 0.001), and the use of additional adjuvant chemotherapy (ACT) decreased (OR 0.78, P < 0.001). A significantly greater use of NACT was noted in patients with TNBC and HER2+ BC, and in all patients aged <50 years compared with older ages (P < 0.001), regardless of biological subtype.
Increased uptake of NACT and decreased use of additional ACT is in keeping with progressive change in practice in response to contemporary evidence. Expansion of BQA data fields related to use of NACT, and detailed audit of NACT rates in Stage II-III TNBC and HER2 enriched BC will allow accurate determination of quality of practice in ANZ.
乳腺外科医生必须掌握有关乳腺癌（BC）患者新辅助化疗（NACT）合理转诊的最新知识。迄今为止，在II - III期HER2富集型和三阴性乳腺癌（TNBC）中观察到的获益最大。本研究是澳大利亚和新西兰首次按BC生物学亚型对NACT使用情况进行分层数据审核。
澳大利亚和新西兰乳腺外科医生（BreastSurgANZ）乳腺癌护理质量审核（BQA）提供了2010年至2019年间116,745例患者的前瞻性数据。确定NACT的年使用率，并通过分数回归分析随时间的变化。将2018年至2019年的数据合并，按生物学亚型（LumA、LumB HER2阴性、LumB HER2阳性、HER2富集型、TNBC、其他基底样型）、年龄（<50岁、51 - 74岁和≥75岁）进行分层，并使用负二项回归进行比较。
NACT的使用逐年增加（OR 1.26，P < 0.001），而额外辅助化疗（ACT）的使用减少（OR 0.78，P < 0.001）。与老年患者相比，TNBC和HER2 + BC患者以及所有<50岁的患者中NACT的使用显著更多（P < 0.001），无论生物学亚型如何。
NACT使用的增加和额外ACT使用的减少与根据当代证据进行的实践渐进性变化一致。扩展与NACT使用相关的BQA数据字段，以及对II - III期TNBC和HER2富集型BC中NACT率的详细审核，将有助于准确确定澳新地区的实践质量。
