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. 2021 Oct;28(11):5895-5905.
doi: 10.1245/s10434-021-09747-9. Epub 2021 Mar 21.

Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma

Natalie Hills #  1 , Macall Leslie #  2 , Rachel Davis #  1 , Marielle Crowell  1 , Hiroyasu Kameyama  2 , Hallgeir Rui  3 , Inna Chervoneva  4 , William Dooley  5 , Takemi Tanaka  6   7
Affiliations

Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma

Natalie Hills et al. Ann Surg Oncol. 2021 Oct.

Abstract

Background: Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer.

Objective: This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer.

Methods: Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging).

Results: T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61-90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05-1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17-1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13-1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging.

Conclusion: TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.

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Conflict of interest statement

Natalie Hills, Macall Leslie, Rachel Davis, Marielle Crowell, Hiroyasu Kameyama, Hallgeir Rui, Inna Chervoneva, William Dooley, and Takemi Tanaka declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Exclusion scheme. NCDB National Cancer Database, TTS time to surgery, IDC invasive ductal carcinoma, DCIS ductal carcinoma in situ, HR hormone receptor, ER estrogen receptor, PR progesterone receptor
Fig. 2
Fig. 2
Association between TTS and T-upstaging (a, b) and N-upstaging (c, d) in HR-positive (left panel) and HR-negative (right panel). OR and CI were calculated relative to the reference (≤30 days TTS). TTS time to surgery, HR hormone receptor, OR odds ratio, CI confidence interval
See this image and copyright information in PMC

References

    1. American Cancer Society . Breast cancer facts & figures 2019–2020. Atlanta: American Cancer Society; 2019.
    1. Liederbach E, Sisco M, Wang C, Pesce C, Sharpe S, Winchester DJ, et al. Wait times for breast surgical operations, 2003–2011: a report from the National Cancer Data Base. Ann Surg Oncol. 2015;22(3):899–907. doi: 10.1245/s10434-014-4086-7. - DOI - PubMed
    1. Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system. Breast Cancer Res Treat. 2019;178(2):441–450. doi: 10.1007/s10549-019-05404-8. - DOI - PubMed
    1. Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg. 2013;148(6):516–523. doi: 10.1001/jamasurg.2013.1680. - DOI - PubMed
    1. Glastonbury CM, Mukherji SK, O'Sullivan B, Lydiatt WM. Setting the stage for 2018: how the changes in the American joint committee on cancer/union for international cancer control. AJNR Am J Neuroradiol. 2017;38(12):2231–2237. doi: 10.3174/ajnr.A5409. - DOI - PMC - PubMed

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