title: 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: OBJECTIVE
  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.
  
  
  METHODS
  Data 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.
  
  
  RESULTS
  Since 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 %.
  
  
  CONCLUSIONS
  Analysis 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.
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany. Elisabeth.Inwald@ukr.de.
authors.forename: E C
authors.initials: EC
authors.lastname: Inwald
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. Michael.Koller@ukr.de.
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.affiliation: Tumor Center Regensburg e.V., University of Regensburg, Josef-Engert-Straße 9, 93053, Regensburg, Germany. Monika.Klinkhammer-Schalke@ukr.de.
authors.forename: M
authors.initials: M
authors.lastname: Klinkhammer-Schalke
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. Florian.Zeman@ukr.de.
authors.forename: F
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria. Ferdinand.Hofstaedter@ukr.de.
authors.forename: F
authors.initials: F
authors.lastname: Hofstädter
authors.affiliation: Tumor Center Regensburg e.V., University of Regensburg, Josef-Engert-Straße 9, 93053, Regensburg, Germany. Patricia.Lindberg@ukr.de.
authors.forename: P
authors.initials: P
authors.lastname: Lindberg
authors.affiliation: Tumor Center Regensburg e.V., University of Regensburg, Josef-Engert-Straße 9, 93053, Regensburg, Germany. Marko.Gerstenhauer@ukr.de.
authors.forename: M
authors.initials: M
authors.lastname: Gerstenhauer
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany. sschueler@caritasstjosef.de.
authors.forename: S
authors.initials: S
authors.lastname: Schüler
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany. otreeck@caritasstjosef.de.
authors.forename: O
authors.initials: O
authors.lastname: Treeck
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany. oortmann@caritasstjosef.de.
authors.forename: O
authors.initials: O
authors.lastname: Ortmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018275:Carcinoma, Lobular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D004703:Endocrine System / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017698:Postmenopause; D017697:Premenopause; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012042:Registries; D015996:Survival Rate; D055815:Young Adult
chemical_list: D047072:Aromatase Inhibitors; D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast cancer; Cancer registry; Endocrine therapy; Overall survival; Steroid hormone receptor