Association of Tumor Molecular Subtype and Stage with Breast and Axillary Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer.

BACKGROUND: Axillary pathologic complete response (pCR) confers higher overall and recurrence-free survival than residual axillary disease. Although breast pCR (ypT0) is associated with a pathologically negative axilla (ypN0) in human epidermal growth factor receptor 2-positive (HER2+) and triple-negative breast cancer (TNBC), how clinical T (cT) and N (cN) staging are associated with ypN0 in other tumor subtypes is incompletely understood. METHODS: A single-institution cancer registry was retrospectively reviewed for patients receiving neoadjuvant chemotherapy (NAC) followed by surgery from 2010 to 2018. Fisher's exact tests compared proportion of breast and axillary pCR by tumor subtype (hormone receptor [HR]-positive /HER2-,HR+/HER2+,HR-/HER2+,HR-/HER2-). Logistic regression determined factors associated with ypN0. Sensitivity analyses determined how cN status affected ypN status by tumor subtype. RESULTS: The study enrolled 1348 patients. The median age was 54 years (interquartile range [IQR], 44-63 years), and 55% of the patients (n = 736) were postmenopausal. The tumor subtypes were HR+/HER2- (12%, n = 155), HR+/HER2+ (48%, n = 653), HR-/HER2+ (25%, n = 343), and TNBC (15%, n = 197). In the study, cT included T0 (1%, n = 18), T1 (20%, n = 272), T2 (53%, n = 713), T3 (17%, n = 230), and T4 (9%, n = 111), and cN included cN0 (51%, n = 687), cN1 (41%, n = 549), cN2 (5%, n = 61), and cN3 (3%, n = 43). Breast pCR and ypN0 occurred most in the HER2+ and TNBC subtypes. A negative association was found between ypN0 and age at diagnosis (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99; p < 0.001), cT4 stage (OR, 0.29; 95% CI, 0.09-0.91; p = 0.034), and HR+ subtypes (HR+/HER2-: OR, 0.54; 95% CI, 0.31-0.94; p = 0.028; HR+/HER2+: OR, 0.60; 95% CI, 0.39-0.93; p = 0.024). The HR-/HER2+ subtype was associated with ypN0 (OR, 1.70; 95% CI, 1.05-2.73; p = 0.030), and cN2/cN3 was negatively associated with ypN0 in HR+/HER2+ disease (OR, 0.26; 95% CI, 0.11-0.61; p = 0.002), HR-/HER2+ disease (OR, 0.42; 95% CI, 0.22-0.77; p = 0.005), and TNBC (OR, 0.11; 95% CI, 0.03-0.40; p = 0.001). CONCLUSION: Tumor subtype, clinical stage, and age at diagnosis may be important in consideration of de-escalation of axillary staging.

Surgeon Personality, Time Spent With the Patient, and Quality of Facilities Are the Most Important Factors to Patients in Selecting an Orthopaedic Sports Medicine Surgeon.

Purpose: To determine the most important factors to patients across the United States in selecting an orthopaedic sports medicine surgeon. Methods: In this cross-sectional survey study, adult U.S. residents were surveyed using Amazon Mechanical Turk, a validated survey tool. Data included demographics and the relative importance of both pre-office and in-office factors that determine how patients select an orthopaedic sports medicine surgeon. Results were compiled, and factors were compared by patient demographics. Results: Of 1,074 respondents, 56.3% were male, and 60.0% were 25 to 40 years old. Responses were geographically diverse. The most important factors in selecting a sports medicine surgeon (graded on a 0-10 scale) were surgeon professionalism and personality (6.6), quality of the hospital/office facilities (6.4), and how much time the surgeon spends with the patient (6.4). Each of these in-office factors were more important than pre-office factors, the most important of which were reputation of the surgeon's hospital or group (6.3), surgeon's reviews on medical review websites (6.2), and surgeon's educational background (6.0). The least important factors were surgeon's sex (3.7), marketing of the surgeon (4.2), and surgeon's social media accounts (4.3). A social media account was taken into consideration at least "a little" by nearly two-thirds of respondents. The most preferred surgeon personality was a balance of professional and lighthearted (66.9%), with strictly professional (27.6%) or largely lighthearted (5.6%) less preferred. Conclusions: The most important factors to patients in selecting their orthopaedic sports medicine surgeon, regardless of patient sex, race, or geography, are related to the patient's in-office experience, including surgeon's professionalism/personality, how much time the surgeon spends with the patient, and quality of the hospital/office facilities. Surgeons should consider prioritizing a professional office environment and taking the time to get to know patients for the benefit of their patients and their practice. Clinical Relevance: The market for orthopaedic sports medicine surgeons is competitive. It is important to know what qualities of a surgeon and his or her practice are important to patients.