title: Predictors of Surgery Types after Neoadjuvant Therapy for Advanced Stage Breast Cancer: Analysis from Florida Population-Based Cancer Registry (1996-2009).
abstract: OBJECTIVE
  Despite the established guidelines for breast cancer treatment, there is still variability in surgical treatment after neoadjuvant therapy (NT) for women with large breast tumors. Our objective was to identify predictors of the type of surgical treatment: mastectomy versus breast-conserving surgery (BCS) in women with T3/T4 breast cancer who received NT.
  
  
  METHODS
  Population-based Florida Cancer Data System Registry, Florida's Agency for Health Care Administration, and US census from 1996 to 2009 were linked for women diagnosed with T3/T4 breast cancer and received NT followed by either BCS or mastectomy. Analysis of multiple variables, such as sociodemographic characteristics (race, ethnicity, socioeconomic status, age, marital status, and urban/rural residency), tumor's characteristics (estrogen/progesterone receptor status, histology, grade, SEER stage, and regional nodes positivity), treatment facilities (hospital volume and teaching status), patients' comorbidities, and type of NT, was performed.
  
  
  RESULTS
  Of 1,056 patients treated with NT for T3/T4 breast cancer, 107 (10%) had BCS and 949 (90%) had mastectomy. After adjusting with extensive covariables, Hispanic patients (adjusted odds ratio (aOR) = [3.50], 95% confidence interval (CI): 1.38-8.84, P = 0.008) were more likely to have mastectomy than BCS. Compared to localized SEER stage, regional stage with direct extension (aOR = [3.24], 95% CI: 1.60-6.54, P = 0.001), regional stage with direct extension and nodes (aOR = [4.35], 95% CI: 1.72-11.03, P = 0.002), and distant stage (aOR = [4.44], 95% CI: 1.81-10.88, P = 0.001) were significantly more likely to have mastectomy than BCS. Compared to patients who received both chemotherapy and hormonal therapy, patients who received hormonal NT only (aOR = [0.29], 95% CI: 0.12-0.68, P = 0.004) were less likely to receive mastectomy.
  
  
  CONCLUSIONS
  Our study suggests that Hispanic ethnicity, advanced SEER stage, and type of NT are significant predictors of receiving mastectomy after NT.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. ; Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: Jamila
authors.initials: J
authors.lastname: Al-Azhri
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. ; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. ; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Feng
authors.initials: F
authors.lastname: Miao
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Constantine
authors.initials: C
authors.lastname: Saclarides
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. ; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Byrne
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. ; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Avisar
keywords: SEER; breast cancer; lumpectomy; mastectomy; neoadjuvant; predictors