Abstract
Use of neoadjuvant chemotherapy in locally advanced breast cancer
in the Netherlands
P.E.R. Spronk1, A.C.M. Van Bommel1, S. Siesling2,3, M.J.T. Baas-
Vrancken Peeters4, C.H. Smorenburg5. 1Leiden University Medical
Centre, Surgery, Leiden, Netherlands; 2Comprehensive Cancer Centre
the Netherlands IKNL, Epidemiology, Utrecht, Netherlands; 3University
of Twente, MIRA Biomedical science and Technical Medicine, Twente,
Netherlands; 4Netherlands Cancer Institute/Antoni van Leeuwenhoek,
Surgery, Amsterdam, Netherlands; 5Netherlands Cancer Institute/Antoni
van Leeuwenhoek, Medical Oncology, Amsterdam, Netherlands
Background: Neoadjuvant chemotherapy (NAC) is the treatment of choice
for patients with locally advanced breast cancer (LABC). The aim of this
study is to examine the use of NAC for LABC in all Dutch hospitals
participating in breast cancer care and to assess what patient, tumour
and hospital characteristics influence its use.
Material and Methods: Data were derived from the national
multidisciplinary NABON Breast Cancer Audit (NBCA), regarding all women
aged >18 years and newly diagnosed with LABC from January 2011 to
September 2013. Multivariable logistic regression was used to assess the
association between the use of NAC and patient, tumour and hospital
related factors.
Results: Of 1419 woman diagnosed with LABC, 70% were treated
with NAC. This percentage varied from 12.5% to 90% between hospitals
and did not increase over time. Factors associated with the use of NAC
included young age, large tumour size, more advanced nodal disease and triple negative or hormone-receptor negative tumours. Also patients
treated in hospitals with a multidisciplinary preoperative work-up and
participation in neoadjuvant studies were more likely to receive NAC.
However, considerable variation between hospitals remained after casemix
correction.
Table 1. Multivariable odds ratios (ORs) for receipt of NAC among 1419
stage III patients 2011 through 2013
OR 95% CI P-value
Age 0.000
<40 0.92 0.44−1.94
40−49 ref.
50−59 0.67 0.41−1.09
60−69 0.51 0.31−0.84
70 0.03 0.02−0.05
Histologic subtype 0.145
ductal ref.
lobular 0.58 0.34−0.98
both 1.19 0.33−4.29
other 0.55 0.20−1.53
Multifocal 0.997
yes ref.
no 1.00 0.67−1.50
Tumor size 0.000
5 cm ref.
>5 cm 5.68 2.34−13.79
Clinical nodal status 0.000
cNx/N0 ref.
cN1 1.32 0.86−2.04
cN2 2.93 1.18−7.29
cN3 10.28 4.18−25.25
Receptor status 0.000
Triple negative 2.35 1.40−3.93
HR−, Her2+ 3.37 1.67−6.78
HR+, Her2+ 0.91 0.51−1.60
HR+, Her2− ref.
Type of surgery 0.026
Breast conservation therapy 2.05 1.09−3.84
Mastectomy ref.
Multidisciplinary team 0.021
Yes 1.98 1.11−3.53
No ref.
Type of hospital 0.569
General 1.20 0.73−1.98
Top clinical ref.
Academic 1.50 0.64−3.47
Hospital surgical volume 0.729
<100 1.19 0.69−2.06
100–200 ref.
>200 1.27 0.70−2.31
Study participation 0.005
Yes 1.80 1.20−2.70
No ref.
Conclusions: There is considerable variation in the use of NAC for LABC
in the Netherlands. Although various patient, tumor and institutional factors
are associated with the use of NAC in LABC, these can only explain part
of the observed variation in treatment patterns between hospitals.
Original language | English |
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Pages | S93-S93 |
Number of pages | 1 |
Publication status | Published - 11 Mar 2016 |
Event | 10th European Breast Cancer Conference (EBCC-10) : Multidisciplinary Innovation in Breast Cancer Care - RAI Amsterdam, Amsterdam, Netherlands Duration: 9 Mar 2016 → 11 Mar 2016 Conference number: 10 |
Conference
Conference | 10th European Breast Cancer Conference (EBCC-10) |
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Abbreviated title | EBCC |
Country/Territory | Netherlands |
City | Amsterdam |
Period | 9/03/16 → 11/03/16 |
Keywords
- METIS-316254
- IR-100066