Risk-adjusted benchmarking of long-term overall survival in patients with HER2-positive early-stage Breast cancer: A Swedish retrospective cohort study
Jacob Thurell,
Narges Manouchehri,
Irma Fredriksson,
Ulla Wilking,
Jonas Bergh,
Lisa Ryden,
Linetta B. Koppert,
Maria M. Karsten,
Narsis A. Kiani,
Elham Hedayati
Affiliations
Jacob Thurell
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Corresponding author. Department of Oncology-Pathology, Karolinska Institute, SE, 17176, Stockholm, Sweden.
Narges Manouchehri
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Algorithmic Dynamics Lab, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
Irma Fredriksson
Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Ulla Wilking
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
Jonas Bergh
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
Lisa Ryden
Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skane University Hospital, Malmö, Sweden
Linetta B. Koppert
Erasmus MC Cancer Institute, Dept of Surgery, Rotterdam, the Netherlands
Maria M. Karsten
Charité – Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
Narsis A. Kiani
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Algorithmic Dynamics Lab, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
Elham Hedayati
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
Aim: The main objective of the current study was to explore the value of risk-adjustment when comparing (i.e. benchmarking) long-term overall survival (OS) in breast cancer (BC) between Swedish regions. We performed risk-adjusted benchmarking of 5- and 10-year OS after HER2-positive early BC diagnosis between Sweden's two largest healthcare regions, constituting approximately a third of the total population in Sweden. Methods: All patients diagnosed with HER2-positive early-stage BC between 01-01–2009 and 31-12-2016 in healthcare regions Stockholm-Gotland and Skane were included in the study. Cox proportional hazards model was used for risk-adjustment. Unadjusted (i.e. crude) and adjusted 5- and 10-year OS was benchmarked between the two regions. Results: The crude 5-year OS was 90.3% in the Stockholm-Gotland region and 87.8% in the Skane region. The crude 10-year OS was 81.7% in the Stockholm-Gotland region and 77.3% in the Skane region. However, when adjusted for age, menopausal status and tumour biology, there was no significant OS disparity between the regions, neither at the 5-year nor 10-year follow-up. Conclusion: This study showed that risk-adjustment is relevant when benchmarking OS in BC, even when comparing regions from the same country that share the same national treatment guidelines. This is, to our knowledge, the first published risk-adjusted benchmarking of OS in HER2-positive BC.
