Table 1.
Female Patients with Stage I-III Breast Cancer by Treatment Sequence, National Cancer Database (2004–2014)
| All Patients (N=693,469) | Upfront Surgery (N=591,143) | NAC (N=85,143) | NAE (N=10,004) | NACE (N=7179) | P-Value | |
|---|---|---|---|---|---|---|
| Age - Median (IQR) | 59 (50 – 69) | 61 (51 – 70) | 51 (43 – 59) | 67 (57 – 77) | 53 (44 – 62) | <0.001 |
| Race/Ethnicity | <0.001 | |||||
| Non-Hispanic White | 526,836 (76%) | 457,505 (77.4%) | 56,644 (66.5%) | 7695 (76.9%) | 4992 (69.5%) | |
| Non-Hispanic Black | 70,695 (10.2%) | 54,742 (9.3%) | 14,128 (16.6%) | 906 (9.1%) | 919 (12.8%) | |
| Hispanic | 34,051 (4.9%) | 26,605 (4.5%) | 6405 (7.5%) | 485 (4.8%) | 556 (7.7%) | |
| Other | 24,553 (3.5%) | 20,061 (3.4%) | 3851 (4.5%) | 365 (3.6%) | 276 (3.8%) | |
| Charlson-Deyo Comorbidity Score | <0.001 | |||||
| 0 | 588,001 (84.8%) | 497,738 (84.2%) | 75,887 (89.1%) | 8041 (80.4%) | 6335 (88.2%) | |
| 1 | 87,081 (12.6%) | 76,909 (13%) | 7963 (9.4%) | 1496 (15%) | 713 (9.9%) | |
| ≥2 | 18,387 (2.7%) | 16,496 (2.8%) | 1293 (1.5%) | 467 (4.7%) | 131 (1.8%) | |
| Facility Type | <0.001 | |||||
| Academic | 206,750 (29.8%) | 170,560 (28.9%) | 30,240 (35.5%) | 3444 (34.4%) | 2506 (34.9%) | |
| Community | 70,331 (10.1%) | 62,271 (10.5%) | 6529 (7.7%) | 902 (9%) | 629 (8.8%) | |
| Comprehensive | 338,121 (48.8%) | 293,814 (49.7%) | 36,805 (43.2%) | 4360 (43.6%) | 3142 (43.8%) | |
| Integrated Network | 78,267 (11.3%) | 64,498 (10.9%) | 11,569 (13.6%) | 1298 (13%) | 902 (12.6%) | |
| Insurance Status | <0.001 | |||||
| Private | 387,868 (55.9%) | 321,917 (54.5%) | 57,573 (67.6%) | 3845 (38.4%) | 4533 (63.1%) | |
| Government | 282,363 (40.7%) | 251,360 (42.5%) | 22,938 (26.9%) | 5779 (57.8%) | 2286 (31.8%) | |
| Not Insured | 14,022 (2%) | 10,083 (1.7%) | 3479 (4.1%) | 195 (1.9%) | 265 (3.7%) | |
| Clinical Stage | <0.001 | |||||
| I | 419,071 (60.4%) | 405,484 (68.6%) | 8246 (9.7%) | 4296 (42.9%) | 1045 (14.6%) | |
| II | 221,872 (32%) | 165,953 (28.1%) | 47,884 (56.2%) | 4361 (43.6%) | 3674 (51.2%) | |
| III | 52,526 (7.6%) | 19,706 (3.3%) | 29,013 (34.1%) | 1347 (13.5%) | 2460 (34.3%) | |
| Tumor Size (cm) - Median (IQR) | 1.7 (1 – 2.6) | 1.5 (1 – 2.3) | 3.2 (2.1 – 5) | 2.2 (1.3 – 3.6) | 3.1 (2 – 5) | <0.001 |
| # LNs Examined - Median (IQR) | 3 (2 – 8) | 3 (2 – 7) | 8 (3 – 15) | 3 (1 – 9) | 8 (3 – 14) | <0.001 |
| # Positive LNs - Median (IQR) | 0 (0 – 1) | 0 (0 – 1) | 1 (0 – 3) | 0 (0 – 1) | 1 (0 – 3) | <0.001 |
| Molecular Subtype* | <0.001 | |||||
| HR+/HER2+ | 43,725 (9.8%) | 31,159 (8.3%) | 10,932 (19.1%) | 386 (5.6%) | 1248 (27%) | |
| HR+/HER2− | 308,548 (69.3%) | 278,443 (74%) | 21,060 (36.8%) | 6168 (89.4%) | 2877 (62.2%) | |
| HR−/HER2+ | 18,335 (4.1%) | 11,405 (3%) | 6791 (11.9%) | 7 (0.1%) | 132 (2.9%) | |
| TNBC | 52,835 (11.9%) | 36,344 (9.7%) | 16,302 (28.5%) | 37 (0.5%) | 152 (3.3%) | |
| Treatment with Chemotherapy | 325,291 (46.9%) | 231,336 (39.1%) | 85,143 (100%) | 1633 (16.3%) | 7179 (100%) | <0.001 |
| Type of Chemotherapy** | - | |||||
| Adjuvant | 232,969 (71.6%) | 231,336 (100%) | 0 (0%) | 1633 (100%) | 0 (0%) | |
| Neoadjuvant | 92,322 (28.4%) | 0 (0%) | 85,143 (100%) | 0 (0%) | 7179 (100%) | |
| Treatment with Radiation | 461,449 (66.5%) | 387,611 (65.6%) | 63,714 (74.8%) | 5362 (53.6%) | 4762 (66.3%) | <0.001 |
| Treatment with Endocrine Therapy | 476,249 (68.7%) | 416,467 (70.5%) | 42,599 (50%) | 10,004 (100%) | 7179 (100%) | <0.001 |
| Type of Endocrine Therapy*** | - | |||||
| Adjuvant | 459,066 (96.4%) | 416,467 (100%) | 42,599 (100%) | 0 (0%) | 0 (0%) | |
| Neoadjuvant | 17,183 (3.6%) | 0 (0%) | 0 (0%) | 10,004 (100%) | 7179 (100%) | |
| Surgical Approach | <0.001 | |||||
| BCS | 433,681 (62.5%) | 394,736 (66.8%) | 31,313 (36.8%) | 5481 (54.8%) | 2151 (30%) | |
| Bilateral Mastectomy for Bilateral Disease | 57 (0%) | 33 (0%) | 22 (0%) | 0 (0%) | 2 (0%) | |
| CPM | 86,506 (12.5%) | 60,765 (10.3%) | 22,646 (26.6%) | 1034 (10.3%) | 2061 (28.7%) | |
| Unilateral Mastectomy | 173,225 (25%) | 135,609 (22.9%) | 31,162 (36.6%) | 3489 (34.9%) | 2965 (41.3%) | |
| Reconstruction (% all ‖ % mastectomy)**** | 89,976 (13% ‖ 34.6%) | 68,482 (11.6% ‖ 34.9%) | 18,362 (21.6% ‖ 34.1%) | 1321 (13.2% ‖ 29.2%) | 1811 (25.2% ‖ 36%) | <0.001 |
| Time to Surgery - Categorical | <0.001 | |||||
| ≤30 Days | 303,924 (43.8%) | 302,241 (51.1%) | 548 (0.6%) | 1109 (11.1%) | 26 (0.4%) | |
| 31–60 Days | 217,683 (31.4%) | 215,027 (36.4%) | 726 (0.9%) | 1880 (18.8%) | 50 (0.7%) | |
| 61–90 Days | 55,934 (8.1%) | 52,868 (8.9%) | 1623 (1.9%) | 1364 (13.6%) | 79 (1.1%) | |
| 91–120 Days | 19,097 (2.8%) | 13,065 (2.2%) | 4818 (5.7%) | 1020 (10.2%) | 194 (2.7%) | |
| 121–180 Days | 44,847 (6.5%) | 5680 (1%) | 35,130 (41.3%) | 1924 (19.2%) | 2113 (29.4%) | |
| >180 Days | 51,984 (7.5%) | 2262 (0.4%) | 42,298 (49.7%) | 2707 (27.1%) | 4717 (65.7%) | |
| Time to Surgery (Days) - Median (IQR) | 35 (21 – 60) | 30 (19 – 46) | 180 (154 – 210) | 109.5 (52 – 188) | 201 (168 – 248) | <0.001 |
| Time to First NST (Days) - Median (IQR) | 30 (21 – 45) | - | 31 (21 – 44) | 27 (14 – 48) | 33 (21 – 51) | <0.001 |
NAC, neoadjuvant chemotherapy only. NACE, neoadjuvant chemotherapy and neoadjuvant endocrine therapy. NAE, neoadjuvant endocrine therapy only. NST, neoadjuvant systemic therapy.
*
Includes only patients diagnosed 2010 and after.
**
Out of patients who underwent chemotherapy.
***
Out of patients who underwent endocrine therapy.
****
Data only available for mastectomy recipients; proportions are calculated out of all patients and out of patients who underwent mastectomy (total n=259,788, Upfront surgery n=196,407, NAC n=53,830, NAE n=4,523, NACE n=5,028).
Percentages may not add up to 100 due to rounding or missingness.