Abstract P5-16-09: Overall survival of patients with non-metastatic triple negative breast cancer who received neoadjuvant vs adjuvant chemotherapy: Cohort analysis of National cancer data base (NCDB) 2010 - 2011
Authors: Cheng YC , Smith E , Yen T 
Published: March 2017

Abstract
Background: One of the benefits of neoadjuvant approach to the treatment of breast cancer is early microscopic disease control, which should translate to improved survival. However, clinical trials have not yet shown a survival benefit for neoadjuvant approach in even high risk patients, such as triple negative cases. Few studies have been performed outside of clinical trials.
Purpose: The objective of our study was to compare the overall survival of Stage I-III triple negative breast cancer patients who received neoadjuvant vs adjuvant chemotherapy within the NCDB, a prospectively collected, large, nationwide, hospital-based cancer outcomes database which contains information for more than 1,500 Commission on Cancer-accredited cancer programs in the U.S.
Patient and Method: We identified a cohort of women, aged &gt; 18 year-old at diagnosis, with clinical stage I-III triple negative breast cancer diagnosed in 2010-2011, who received either neoadjuvant chemotherapy only or adjuvant chemotherapy only. Patients with incomplete or missing vital status, receptors status and treatment information were excluded. Demographic (age at diagnosis, race, ethnicity, comorbidities, insurance, median income, urbanicity), tumor (clinical stage, histology, grade) and treatment (breast surgery, surgical margin, radiation) factors were examined. Stabilized inverse proportion weights were developed and assigned to balance the neoadjuvant and adjuvant groups on all demographic, tumor and treatment covariates. Unadjusted and adjusted overall survival was calculated using the Kaplan-Meier method and compared using the log-rank test.
Results: Among the 15,483 women with triple negative breast cancer, 4,335 (28%) received neoadjuvant chemotherapy and 11,148 (72%) received adjuvant chemotherapy. Most of the demographic, tumor and treatment factors were similarly distributed among neoadjuvant and adjuvant groups except age at diagnosis and clinical stage. Compared to patients received adjuvant chemotherapy, patients received neoadjuvant chemotherapy were more likely to be younger (45% vs. 31% &lt; 50 year-old, p&lt;0.0001) and have a higher clinical stage (35% vs. 6% stage III, p&lt;0.0001). The unadjusted 4-year overall survival of patients received neoadjuvant vs adjuvant approach was 75.8% (95% CI 74.4%-77.4%) and 87.5% (95% CI 87.1%-87.9%), respectively. After adjusting for demographic, tumor and treatment factors, the 4-year overall survival of patients received neoadjuvant vs adjuvant approach was 81.9% (95% CI 79.5%-84.3%) and 85.3% (95% CI 85.2%-85.4%), respectively.
Conclusion: In this NCDB study, the overall survival of triple negative breast cancer patients received neoadjuvant chemotherapy was inferior to those received adjuvant chemotherapy, even after adjusting for demographic, tumor and treatment factors. However, information regarding the chemotherapy regimen used and whether a full course of chemotherapy was delivered (2 factors that affect disease response and outcome) was not available. Patient and tumor factors at the time of disease presentation that are important in determining which triple negative patients will benefit from neoadjuvant approach remain to be defined.
Citation Format: Cheng YC, Smith E, Yen T. Overall survival of patients with non-metastatic triple negative breast cancer who received neoadjuvant vs adjuvant chemotherapy: Cohort analysis of National cancer data base (NCDB) 2010 - 2011 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-09.