PURPOSE Delays in initiating adjuvant endocrine therapy (AET) are a cause for concern among women with breast cancer and clinicians, but the impact of delayed AET on overall survival (OS) is unclear. This study seeks to describe the relationship between delayed AET and OS. METHODS Retrospective cohort study of women with stage II and III hormone receptor positive, human epidermal receptor 2 negative, invasive breast cancer, identified from the National Cancer Database. The primary exposure delayed AET, was defined as initiation of AET more than 12 months after breast cancer diagnosis. Using logistic regression, we examined predictors of delayed AET. The survival analysis with Cox proportional hazards regression adjusted for patient, tumor, and treatment characteristics. RESULTS Among the 391,594 included women, 12,162 (3.1%) had delayed AET. Predictors of delayed AET included Black race (adjusted odds ratio [aOR] = 1.61, 95% confidence interval [CI] 1.52-1.70) or Hispanic ethnicity (aOR = 1.25, 95% CI 1.16-1.35) vs white race, Medicare (aOR = 1.13, 95% CI 1.06-1.20) or Medicaid (aOR = 1.41, 95% CI 1.32-1.50) versus private insurance, and cancer stage III (aOR = 1.24, 95% CI 1.19-1.30) vs stage II. With median follow-up of 67.4 months, 67,335 (17.2%) patients died. Delayed AET had no statistically significant effect on the hazard of death (adjusted hazards ratio = 1.01; 95% CI 0.96-1.06) compared to initiation within 12 months of diagnosis. CONCLUSION This study suggests that there may be no adverse impact on survival if initiation of AET occurs 12 to 24 months after initial diagnosis compared to within 12 months of diagnosis as currently recommended.

中文翻译：

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延迟启动辅助内分泌治疗对乳腺癌女性生存率的影响。

目的 延迟启动辅助内分泌治疗 (AET) 是乳腺癌女性和临床医生关注的一个原因，但延迟 AET 对总生存 (OS) 的影响尚不清楚。本研究旨在描述延迟 AET 与 OS 之间的关系。方法 对从国家癌症数据库确定的 II 期和 III 期激素受体阳性、人表皮受体 2 阴性、浸润性乳腺癌的女性进行回顾性队列研究。主要暴露延迟 AET，定义为在乳腺癌诊断后 12 个月后开始 AET。使用逻辑回归，我们检查了延迟 AET 的预测因素。使用 Cox 比例风险回归的生存分析针对患者、肿瘤和治疗特征进行了调整。结果 在纳入的 391,594 名女性中，12,162 (3.1%) 名发生了 AET 延迟。AET 延迟的预测因素包括黑人（调整后的优势比 [aOR] = 1.61，95% 置信区间 [CI] 1.52-1.70）或西班牙裔（aOR = 1.25，95% CI 1.16-1.35）与白人、医疗保险（aOR） = 1.13, 95% CI 1.06-1.20) 或医疗补助 (aOR = 1.41, 95% CI 1.32-1.50) 与私人保险，以及癌症 III 期 (aOR = 1.24, 95% CI 1.19-1.30) 与 II 期。中位随访时间为 67.4 个月，67,335（17.2%）名患者死亡。与诊断后 12 个月内开始相比，延迟 AET 对死亡风险（调整后的风险比 = 1.01；95% CI 0.96-1.06）没有统计学意义的影响。结论 本研究表明，与目前推荐的在诊断后 12 个月内开始 AET 相比，如果在初始诊断后 12 至 24 个月开始 AET，可能不会对生存率产生不利影响。