Does Immediate Breast Reconstruction Lead to a Delay in Adjuvant Chemotherapy for Breast Cancer? A Meta-Analysis and Systematic Review

Immediate breast reconstruction on overall and breast cancer-specific survival: A propensity score matched analysis

BACKGROUND

The trend towards breast reconstruction post-mastectomy has increased, aiming to enhance patient outcomes and quality of life. This study examines the impact of immediate breast reconstruction (IBR) on survival outcomes compared to mastectomy alone (MA).

MATERIALS AND METHODS

We conducted a retrospective cohort study of breast cancer patients aged 20-79 years with MA or IBR from 2010 to 2015. Propensity score matching (PSM) was utilized to balance the cohorts. Survival analysis assessed overall survival (OS) and breast cancer specific survival (BCSS), with subgroup analysis was performed.

RESULTS

The median follow-up period was 93 months. After PSM, 16,220 female patients were matched. IBR was associated with improved OS (HR = 0.74, 95 % CI 0.69-0.79, p < 0.001) and BCSS (HR = 0.84, 95 % CI 0.78-0.91, p < 0.001). Patients who needed radiotherapy tended not to receive IBR. IBR achieved a survival advantage in OS across the subgroups including age, marital status, histology grade, T stage, N stage, chemotherapy status, and radiotherapy status. In patients aged 60-79 years, with Black ethnicity, with local median household income <$50,000, IBR's survival advantage is in OS but not BCSS and IBR was not inclined to be chosen among these groups.

CONCLUSION

IBR's OS advantage over MA is universal in all stratified age groups, marital statuses, histology grades, T/N stages, and chemo/radiotherapy statuses. For patients aged 60-79 years, with Black ethnicity, with a local median household income <$50,000 and requiring radiotherapy, IBR is survival-beneficial but these groups tend not to receive it.

Regional differences in neo/adjuvant chemotherapy timing in patients with early-stage triple-negative breast cancer in England

PURPOSE

Triple-negative breast cancer (TNBC) is an aggressive breast cancer histological type that is predictive of poor outcomes, shorter remission periods and reduced survival. TNBC is treated with surgery and neo/adjuvant chemotherapy, with evidence of association between longer periods from surgery to adjuvant chemotherapy (time to chemotherapy, TTC) and poorer survival outcomes. This study investigated regional differences in TTC period between regions and ethnic groups to evaluate equity of care in the English TNBC population. Time from neoadjuvant chemotherapy to surgery (time to surgery, TTS) was also compared between groups.

METHODS

This retrospective cohort study compared TTC and TTS periods in TNBC patients in England over a two-year period. TTC and TTS were compared by English region and ethnicity, testing for significant differences in treatment pathway timing by these demographics.

RESULTS

1347 TNBC patients were included in the study. Significant regional differences in TTC were observed, with the longest median period of 50 days (IQR 36, 83) in the Midlands compared to 38 days (IQR 27, 55) in the North West (p < 0.001). No significant differences in TTS were observed between regions. Ethnicity was not significantly associated with timeliness of neo/adjuvant chemotherapy initiation (p > 0.05).

CONCLUSION

These findings suggest regional differences in TTC for patients treated with surgery and chemotherapy for TNBC. Given evidence of increased mortality risk as the TTC period increases, the causes of regional disparities warrant further investigation. This study can inform targets for improvement in the delivery of adjuvant chemotherapy in cancer treatment centres in England.

Deep learning-guided adjuvant chemotherapy selection for elderly patients with breast cancer

PURPOSE

The efficacy of adjuvant chemotherapy in elderly breast cancer patients is currently controversial. This study aims to provide personalized adjuvant chemotherapy recommendations using deep learning (DL).

METHODS

Six models with various causal inference approaches were trained to make individualized chemotherapy recommendations. Patients who received actual treatment recommended by DL models were compared with those who did not. Inverse probability treatment weighting (IPTW) was used to reduce bias. Linear regression, IPTW-adjusted risk difference (RD), and SurvSHAP(t) were used to interpret the best model.

RESULTS

A total of 5352 elderly breast cancer patients were included. The median (interquartile range) follow-up time was 52 (30-80) months. Among all models, the balanced individual treatment effect for survival data (BITES) performed best. Treatment according to following BITES recommendations was associated with survival benefit, with a multivariate hazard ratio (HR) of 0.78 (95% confidence interval (CI): 0.64-0.94), IPTW-adjusted HR of 0.74 (95% CI: 0.59-0.93), RD of 12.40% (95% CI: 8.01-16.90%), IPTW-adjusted RD of 11.50% (95% CI: 7.16-15.80%), difference in restricted mean survival time (dRMST) of 12.44 (95% CI: 8.28-16.60) months, IPTW-adjusted dRMST of 7.81 (95% CI: 2.93-11.93) months, and p value of the IPTW-adjusted Log-rank test of 0.033. By interpreting BITES, the debiased impact of patient characteristics on adjuvant chemotherapy was quantified, which mainly included breast cancer subtype, tumor size, number of positive lymph nodes, TNM stages, histological grades, and surgical type.

CONCLUSION

Our results emphasize the potential of DL models in guiding adjuvant chemotherapy decisions for elderly breast cancer patients.

Recommandations francophones pour la pratique clinique concernant la prise en charge des cancers du sein de Saint-Paul-de-Vence 2022-2023

With more than 60,000 new cases of breast cancer in mainland France in 2023 and 8% of all cancer deaths, breast cancer is the leading cancer in women in terms of incidence and mortality. While the number of new cases has almost doubled in 30 years, the percentage of patients at all stages alive at 5 years (87%) and 10 years (76%) testifies to the major progress made in terms of screening, characterisation and treatment. However, this progress, rapid as it is, needs to be evaluated and integrated into an overall strategy, taking into account the characteristics of the disease (stage and biology), as well as those of the patients being treated. These are the objectives of the St Paul-de-Vence recommendations for clinical practice. We report here the summary of the votes, discussions and conclusions of the Saint-Paul-de-Vence 2022-2023 RPCs.