Table 2.
Breast cancer clinical management according to each classic subtype
| ER-positive/HER2-negative | HER2-positive | TNBC | P value | |
| n=108 | n=50 | n=52 | ||
| Time from first symptom until diagnosis (n, %) | 0.468 | |||
| <180 days | 30 (50.8) | 13 (48.1) | 13 (65.0) | |
| ≥180 days | 29 (49.2) | 14 (51.9) | 7 (35.0) | |
| Missing | 49 | 23 | 32 | |
| Timing of diagnosis (n, %) | 0.729 | |||
| Pre-MTB implementation | 46 (50.5) | 22 (50.0) | 23 (57.5) | |
| Post-MTB implementation | 45 (49.5) | 22 (50.0) | 17 (42.5) | |
| Not applicable* | 17 | 6 | 12 | |
| Type of first treatment received (n, %) | 0.069 | |||
| No treatment received | 1 (1.1) | 0 | 2 (5.0) | |
| Surgery | 17 (18.9) | 14 (31.8) | 14 (35.0) | |
| Chemotherapy/endocrine therapy† | 72 (80.0) | 30 (68.2) | 24 (60.0) | |
| Missing | 18 | 6 | 12 | |
| Time from diagnosis until first treatment (n, %) | 0.083 | |||
| <45 days | 36 (40.4) | 26 (59.1) | 21 (55.3) | |
| ≥45 days | 53 (59.6) | 18 (40.9) | 17 (44.7) | |
| Missing | 19 | 6 | 14 | |
| Surgery (ever) (n, %) | 0.030 | |||
| No | 17 (18.3) | 1 (2.2) | 6 (15.0) | |
| Yes | 76 (81.7) | 45 (97.8) | 34 (85.0) | |
| Missing | 15 | 4 | 12 | |
| Surgical intent (n, %)‡ | 0.971 | |||
| Diagnostic | 3 (3.9) | 1 (2.2) | 1 (2.9) | |
| Curative | 61 (80.3) | 37 (82.2) | 28 (82.4) | |
| Palliative | 8 (10.5) | 4 (8.9) | 2 (5.9) | |
| Unknown | 4 (5.3) | 3 (6.7) | 3 (8.8) | |
| Type of breast surgery (n, %)§ | ||||
| Total mastectomy | 70 (92.1) | 41 (91.1) | 33 (97.1) | 0.553 |
| Tumourectomy | 6 (7.9) | 4 (8.9) | 1 (2.9) | |
| Status of surgical margins (n, %) | 0.431 | |||
| Clean | 64 (91.4) | 36 (92.3) | 26 (83.9) | |
| Positive | 6 (8.6) | 3 (7.7) | 5 (16.1) | |
| Missing | 6 | 6 | 3 | |
| Axillary surgery—type (n, %)¶ | ||||
| Axillary dissection | 66 (98.5) | 40 (88.9) | 31 (100) | 0.586 |
| Sentinel lymph node biopsy | 1 (1.5) | 0 | 0 | |
| Not done/missing | 9 | 5 | 3 | |
| Axillary surgery—completeness (n, %)** | 0.710 | |||
| Not done/no isolated lymph nodes | 9 (11.8) | 5 (11.9) | 3 (9.1) | |
| Incomplete | 21 (27.6) | 7 (16.7) | 9 (27.3) | |
| Complete | 46 (60.5) | 30 (71.4) | 21 (63.6) | |
| Missing | 0 | 3 | 1 | |
| Chemotherapy (ever) (n, %) | 0.413 | |||
| No | 4 (4.4) | 2 (4.5) | 4 (10.0) | |
| Yes | 87 (95.6) | 42 (95.5) | 36 (90.0) | |
| Missing | 17 | 6 | 12 | |
| Intent of first-line CT (n, %)†† | 0.075 | |||
| Neoadjuvant only | 16 (18.4) | 2 (4.8) | 2 (5.6) | |
| Neoadjuvant+adjuvant | 42 (48.3) | 25 (59.5) | 16 (44.4) | |
| Adjuvant only | 12 (13.8) | 10 (23.8) | 10 (27.8) | |
| Palliative | 17 (19.5) | 5 (11.9) | 8 (22.2) | |
| Neoadjuvant CT—outcome (n, %) | 0.017 | |||
| Same stage | 14 (24.1) | 13 (48.1) | 10 (55.6) | |
| Upstaging | 7 (12.1) | 6 (22.2) | 1 (5.6) | |
| Downstaging | 26 (44.8) | 8 (29.6) | 6 (33.3) | |
| Unknown‡‡ | 11 (19.0) | 0 | 1 (5.6) | |
| pCR rate after neoadjuvant CT (n, %) | 0.825 | |||
| No pCR | 55 (93.2) | 26 (96.3) | 16 (88.9) | |
| pCR only in the breast (ypT0/is) | 2 (3.4) | 1 (3.7) | 1 (5.6) | |
| pCR in the breast and lymph nodes (ypT0/is, ypN0) | 2 (3.4) | 0 | 1 (5.6) | |
| Type of first-line CT regimen (n, %)†† | 0.086 | |||
| Anthracycline-based only | 43 (49.4) | 13 (31.0) | 20 (55.6) | |
| Anthracyclines+taxanes based | 40 (46.0) | 28 (66.7) | 15 (41.7) | |
| Other§§ | 4 (4.6) | 1 (2.4) | 1 (2.8) | |
| First-line CT dose intensity (n, %)†† | 0.263 | |||
| <85% | 47 (57.3) | 20 (50.0) | 24 (68.6) | |
| ≥85% | 35 (42.7) | 20 (50.0) | 11 (31.4) | |
| Missing | 5 | 2 | 1 | |
| Cumulative dose of doxorubicin in mg/m2 (median, range) | 240 (60–420) | 240 (120–360) | 240 (120–360) | 0.75 |
| Endocrine therapy (ever) (n, %) | <0.001 | |||
| No | 30 (33.3) | 19 (43.2) | 31 (79.5) | |
| Yes | 60 (66.7) | 25 (56.8) | 8 (20.5) | |
| Missing | 18 | 6 | 13 | |
| Radiotherapy (ever) (n, %) | 0.358 | |||
| No | 86 (95.6) | 40 (90.9) | 39 (97.5) | |
| Yes | 4 (4.4) | 4 (9.1) | 1 (2.5) | |
| Missing | 18 | 6 | 12 |
P values in bold are considered to be statistically significant (<0.05).
*Not applicable as patients were not treated/followed at the Maputo Central Hospital and, therefore, were not discussed by the multidisciplinary tumour board.
†One patient received endocrine therapy as first treatment, who had a luminal B-like tumour.
‡Patients submitted to a surgical biopsy with diagnostic intent followed by a tumourectomy or a mastectomy with curative intent were included in the ‘Curative’ intent group.
§Patients submitted to a tumourectomy followed by a mastectomy were included in the ‘Mastectomy’ group.
¶One patient received a sentinel lymph node biopsy followed by an axillary dissection and was, therefore, included in the ‘Axillary dissection’ group.
**Among patients receiving any type of breast surgery (n=155). Not done: not done or no isolated lymph nodes; incomplete: 1–5 isolated lymph nodes (in case of axillary lymph node dissection); complete: ≥6 isolated lymph nodes (in case of axillary lymph node dissection) or ≥1 isolated lymph nodes with ≤2 positive lymph nodes (in case of sentinel lymph node biopsy).
††First line of chemotherapy that the patient received includes neoadjuvant, adjuvant or palliative treatment. If the patient received part of chemotherapy as neoadjuvant (eg, AC regimen), and another part as adjuvant chemotherapy (eg, paclitaxel), the type of regimen and dose intensity refer to the entire scheme (neoadjuvant plus adjuvant).
‡‡Cases in whom there were missing data regarding clinical staging or patient-abandoned treatment.
§§Includes: taxane-based CT (three patients), non-anthracycline/non-taxane-based CT (two patients) and unknown regimen (one patient). The preferred anthracycline-containing regimen was AC (cyclophosphamide 600 mg/m2 and doxorubicin 60 mg/m2 every 3 weeks) and the preferred taxane used was paclitaxel (175 mg/m2 every 3 weeks); dose-dense regimens were not used due to the unpredictable availability of granulocyte-colony stimulating factors.
CT, chemotherapy; ER, oestrogen receptor; HER2, human epidermal growth factor receptor 2; MTB, multidisciplinary tumour board; pCR, pathological complete response; TNBC, triple-negative breast cancer.