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Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple‐negative breast cancer
Author(s) -
Heeg Erik,
Marangvan de Mheen Perla J.,
Van Maaren Marissa C.,
Schreuder Kay,
Tollenaar Rob A.E.M.,
Siesling Sabine,
Bos Monique E.M.M.,
Vrancken Peeters MarieJeanne T.F.D.
Publication year - 2019
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.32788
Subject(s) - medicine , hazard ratio , breast cancer , mastectomy , triple negative breast cancer , chemotherapy , proportional hazards model , oncology , surgery , cancer , adjuvant , adjuvant chemotherapy , gastroenterology , confidence interval
Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype‐dependent and that TTC within 30 days should be warranted in patients with triple‐negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10‐year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast‐conserving surgery (BCS) vs . mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity‐score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS ( n = 904), 10‐year overall survival was favorable for patients with TTC within 30 days (84.4% vs . 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy ( n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs . 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted.