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Survival After Multimodal Treatment for Breast Cancer in Brazil: The Predominant Role of Clinical Stage and Treatment
Júlio Cesar Prestes1, Andre Guimares Gouveia2, Maurício Fraga da Silva3
1Hospital Sírio Libanês, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil.
Background:
Neoadjuvant systemic therapy (NST) enables early systemic disease control and assessment of treatment response in breast cancer. Survival after NST may also be influenced by subsequent local-regional treatment. We evaluated clinical and selected nonclinical factors associated with survival among Brazilian women treated with NST followed by surgery and radiotherapy.
Methods:
This subanalysis of the LACOG 0115 Amazona III cohort included women aged ≥18 years with nonmetastatic breast cancer treated with NST, surgery, and radiotherapy at 22 Brazilian centers from 2016 to 2018. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methods and assessed using multivariable Cox regression.
Results:
Among 2,972 enrolled patients, 582 met inclusion criteria. Median age was 49 years; 74.1% were treated in the public health care system, 57.2% were non-White, and 58.9% had stage III disease. Stage III disease was associated with worse OS (hazard ratio [HR], 1.96; 95% CI, 1.05-3.70; P = .034) and DFS (HR, 1.69; 95% CI, 1.02-2.86; P = .041) compared with stage II disease. Absence of pathologic complete response was associated with inferior OS (HR, 3.53; 95% CI, 1.27-9.77; P = .015) and DFS (HR, 2.24; 95% CI, 1.11-4.52; P = .024). Educational level, race, and insurance status were not independently associated with OS or DFS.
Conclusions:
Tumor stage and achievement of pathologic complete response were the principal independent prognostic factors. Socioeconomic and health care-related variables were not independently associated with survival after adjustment.
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