Abstract：
OBJECTIVE: Neoadjuvant chemotherapy (NAC) for triple-negative (TN) and Her2-positive (HER2) breast cancers is supported by international guidelines as it can decrease extent of surgery, provide prognostic information, and allow response-driven adjuvant therapies. Our goal was to describe practice patterns for patients with TN and HER2-positive breast cancer and identify the factors associated with the receipt of NAC versus surgery as initial treatment.
METHODS: A retrospective population-based cohort study of adult women diagnosed with stage I-III TN or HER2-positive breast cancer (2012-2020) in Ontario was completed using linked administrative datasets. The primary outcome was NAC as first treatment. The association between NAC and patient, tumor, and practice-related factors was examined using multivariable logistic regression models.
RESULTS: Of 14,653 patients included, 23.9% (n = 3500) underwent NAC as first treatment. Patients who underwent NAC were more likely to be younger and have larger tumors, node-positive disease, and stage 3 disease. Of patients who underwent surgery first, 8.8% were seen by a medical oncologist prior to surgery. On multivariable analysis, increasing tumor size (T2 vs T1/T0: 2.75 (2.31-3.28)) and node-positive (N1 vs N0: OR 3.54 (2.92-4.30)) disease were both associated increased odds of receiving NAC.
CONCLUSIONS: A considerable proportion of patients with TN and HER2-positive breast cancer do not receive NAC as first treatment. Of those, most were not assessed by both a surgeon and medical oncologist prior to initiating therapy. This points toward potential gaps in multidisciplinary assessment and disparities in receipt of guideline-concordant care.
METHODS: A retrospective population-based cohort study of adult women diagnosed with stage I-III TN or HER2-positive breast cancer (2012-2020) in Ontario was completed using linked administrative datasets. The primary outcome was NAC as first treatment. The association between NAC and patient, tumor, and practice-related factors was examined using multivariable logistic regression models.
RESULTS: Of 14,653 patients included, 23.9% (n = 3500) underwent NAC as first treatment. Patients who underwent NAC were more likely to be younger and have larger tumors, node-positive disease, and stage 3 disease. Of patients who underwent surgery first, 8.8% were seen by a medical oncologist prior to surgery. On multivariable analysis, increasing tumor size (T2 vs T1/T0: 2.75 (2.31-3.28)) and node-positive (N1 vs N0: OR 3.54 (2.92-4.30)) disease were both associated increased odds of receiving NAC.
CONCLUSIONS: A considerable proportion of patients with TN and HER2-positive breast cancer do not receive NAC as first treatment. Of those, most were not assessed by both a surgeon and medical oncologist prior to initiating therapy. This points toward potential gaps in multidisciplinary assessment and disparities in receipt of guideline-concordant care.
摘要：
目的：三阴性（TN）和Her2阳性（HER2）乳腺癌的新辅助化疗（NAC）得到了国际指南的支持，因为它可以降低手术范围。提供预后信息，并允许反应驱动的辅助治疗。我们的目标是描述TN和HER2阳性乳腺癌患者的实践模式，并确定与接受NAC和手术作为初始治疗相关的因素。
方法：使用关联的管理数据集，对安大略省诊断为I-III期TN或HER2阳性乳腺癌（2012-2020）的成年女性进行了一项基于人群的回顾性队列研究。主要结果是NAC作为第一治疗。NAC和病人之间的联系，肿瘤，使用多变量逻辑回归模型检查与实践相关的因素。
结果：在14,653名患者中，23.9%(n=3500)接受NAC作为首次治疗。接受NAC的患者更可能更年轻，肿瘤更大，淋巴结阳性疾病，3期疾病。在先接受手术的患者中，8.8%的患者在手术前被肿瘤科医生看到。在多变量分析中，肿瘤大小增加(T2vsT1/T0:2.75(2.31-3.28))和淋巴结阳性(N1vsN0:OR3.54(2.92-4.30))均与接受NAC的几率增加相关.
结论：有相当比例的TN和HER2阳性乳腺癌患者不接受NAC作为第一治疗。其中,大多数患者在开始治疗前没有由外科医生和内科肿瘤学家进行评估.这指出了多学科评估中的潜在差距以及在接受指南一致护理方面的差距。
方法：使用关联的管理数据集，对安大略省诊断为I-III期TN或HER2阳性乳腺癌（2012-2020）的成年女性进行了一项基于人群的回顾性队列研究。主要结果是NAC作为第一治疗。NAC和病人之间的联系，肿瘤，使用多变量逻辑回归模型检查与实践相关的因素。
结果：在14,653名患者中，23.9%(n=3500)接受NAC作为首次治疗。接受NAC的患者更可能更年轻，肿瘤更大，淋巴结阳性疾病，3期疾病。在先接受手术的患者中，8.8%的患者在手术前被肿瘤科医生看到。在多变量分析中，肿瘤大小增加(T2vsT1/T0:2.75(2.31-3.28))和淋巴结阳性(N1vsN0:OR3.54(2.92-4.30))均与接受NAC的几率增加相关.
结论：有相当比例的TN和HER2阳性乳腺癌患者不接受NAC作为第一治疗。其中,大多数患者在开始治疗前没有由外科医生和内科肿瘤学家进行评估.这指出了多学科评估中的潜在差距以及在接受指南一致护理方面的差距。
