Adjuvant endocrine therapy in pre- versus postmenopausal patients with steroid hormone receptor-positive breast cancer: results from a large population-based cohort of a cancer registry

Abstract

Purpose Adjuvant endocrine therapy (ET) is indicated in patients with steroid hormone receptor (HR)-positive breast cancer. The aim of this study was to evaluate the quality of HR determination and adjuvant endocrine treatment of breast cancer patients in a large cohort of more than 7000 women by analyzing data from a population-based regional cancer registry.MethodsData from the Clinical Cancer Registry Regensburg (Bavaria, Germany) were analyzed. Female patients with primary, nonmetastatic invasive breast cancer who were diagnosed between 2000 and 2012 (n = 7421) were included. HR-status was available in 97.4 % (n = 7229) of the patients. This data set (n = 7229) was used for subsequent statistical analyses.ResultsSince 2009, almost a complete rate of 99.6 % of analyzed HR-status was achieved. In sum, 85.8 % of the patients (n = 6199) were HR-positive, whereas 14.2 % (n = 1030) were HR-negative. Overall, 85.3 % (n = 5285) of HR-positive patients received ET either alone or in combination with chemotherapy (CHT) and/or trastuzumab. The majority of premenopausal patients received CHT plus ET (716 patients, 52.3 %). In postmenopausal patients, the most frequent systemic therapy was ET alone (2670 patients, 55.3 %). Best overall survival (OS) was found in HER2-/HR-positive patients receiving CHT plus ET plus trastuzumab (7-year OS rate of 97.2 % in premenopausal patients versus 86.9 % in postmenopausal patients). Premenopausal patients had a reduced benefit from additional CHT than postmenopausal patients. Premenopausal patients receiving only ET had a 7-year OS rate of 95.3 % compared to 92.7 % of patients receiving CHT plus ET. In contrast, postmenopausal patients treated with CHT plus ET had a 7-year OS rate of 84.0 % in comparison with those patients receiving only ET with a 7-year OS rate of 81.7 %.ConclusionsAnalysis of HR in patients with early breast cancer achieved a very high quality in recent years. The vast majority of HR-positive patients received ET, and this guideline-adherent use improved OS. Inverse effects of the CHT plus ET combination in premenopausal versus postmenopausal patients and a still existing minority of patients not receiving guideline-adherent treatment should be further investigated in future studies.

4-IHC classification of breast cancer subtypes in a large cohort of a clinical cancer registry: use in clinical routine for therapeutic decisions and its effect on survival

“…Immuno-histochemical determination of 4-IHC was performed consistent with defined standards as described in detail in previous studies of our group [ 10 – 12 ].…”

Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment

“…Historically, concerns about the completeness and accuracy of registry data led to caution when using these data to assess care quality; however, more recent studies have demonstrated improvements in registry data, [19][20][21][22][23] and investigators are now using them to measure quality. 24,25 Still, we excluded measures that could not be ascertained from registry data (eg, use of tumor markers or imaging studies). A concordance value was derived for each measure using the overall percentage method, 26 in which concordance equals the number of patients who received recommended care divided by the number eligible for each measure.…”

Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma

“…In Bavaria, the law on the Bavarian Epidemiologic Cancer Registry (Gesetz über das bevölkerungsbezogene Krebsregister Bayern-BayKRG) allows the continuous and uniform data acquisition and processing of cancer incidences by means of an epidemiologic cancer registry [9]. The purpose of this law is to regulate cancer control and to improve data quality of cancer epidemiology.…”

“…Each patient has the right to object data storage at any time. On the basis of this law, retrospective analyses of anonymous data require no additional ethics statement [9].…”