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Love RR, Laudico AV, Van Dinh N, Allred DC, Uy GB, Quang LH, Salvador JDS, Siguan SSS, Mirasol-Lumague MR, Tung ND, Benjaafar N, Navarro NS, Quy TT, De La Peña AS, Dofitas RB, Bisquera OC, Linh ND, To TV, Young GS, Hade EM, Jarjoura D. Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer. J Natl Cancer Inst 2015; 107:djv064. [PMID: 25794890 DOI: 10.1093/jnci/djv064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND For women with hormone receptor-positive, operable breast cancer, surgical oophorectomy plus tamoxifen is an effective adjuvant therapy. We conducted a phase III randomized clinical trial to test the hypothesis that oophorectomy surgery performed during the luteal phase of the menstrual cycle was associated with better outcomes. METHODS Seven hundred forty premenopausal women entered a clinical trial in which those women estimated not to be in the luteal phase of their menstrual cycle for the next one to six days (n = 509) were randomly assigned to receive treatment with surgical oophorectomy either delayed to be during a five-day window in the history-estimated midluteal phase of the menstrual cycles, or in the next one to six days. Women who were estimated to be in the luteal phase of the menstrual cycle for the next one to six days (n = 231) were excluded from random assignment and received immediate surgical treatments. All patients began tamoxifen within 6 days of surgery and continued this for 5 years. Kaplan-Meier methods, the log-rank test, and multivariable Cox regression models were used to assess differences in five-year disease-free survival (DFS) between the groups. All statistical tests were two-sided. RESULTS The randomized midluteal phase surgery group had a five-year DFS of 64%, compared with 71% for the immediate surgery random assignment group (hazard ratio [HR] = 1.24, 95% confidence interval [CI] = 0.91 to 1.68, P = .18). Multivariable Cox regression models, which included important prognostic variables, gave similar results (aHR = 1.28, 95% CI = 0.94 to 1.76, P = .12). For overall survival, the univariate hazard ratio was 1.33 (95% CI = 0.94 to 1.89, P = .11) and the multivariable aHR was 1.43 (95% CI = 1.00 to 2.06, P = .05). Better DFS for follicular phase surgery, which was unanticipated, proved consistent across multiple exploratory analyses. CONCLUSIONS The hypothesized benefit of adjuvant luteal phase oophorectomy was not shown in this large trial.
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Affiliation(s)
- Richard R Love
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.).
| | - Adriano V Laudico
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Nguyen Van Dinh
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - D Craig Allred
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Gemma B Uy
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Le Hong Quang
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Jonathan Disraeli S Salvador
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Stephen Sixto S Siguan
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Maria Rica Mirasol-Lumague
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Nguyen Dinh Tung
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Noureddine Benjaafar
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Narciso S Navarro
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Tran Tu Quy
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Arturo S De La Peña
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Rodney B Dofitas
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Orlino C Bisquera
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Nguyen Dieu Linh
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Ta Van To
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Gregory S Young
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - Erinn M Hade
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
| | - David Jarjoura
- International Breast Cancer Research Foundation, Madison, WI (RRL); University of the Philippines Manila, Philippine General Hospital, Manila, Philippines (AL, GU, ADP, RD, OB); Hospital K, Hanoi, Vietnam (NVD, LHQ, NDL, TVT); Clarient Pathology Services, Aliso Viejo, CA (DCA); East Avenue Medical Center, Manila, Philippines (JS); Vicente Sotto Hospital, Cebu, Philippines (SSS); Rizal Medical Center, Manila, Philippines (RML, MHA); Hue Central Hospital, Hue, Vietnam (NDT); National Institute of Oncology, Rabat, Morocco (NB); Santo Tomas University Hospital, Manila, Philippines (NN); Danang General Hospital, Danang, Vietnam (TTQ); The Ohio State University Center for Biostatistics, Columbus, OH (GSY, EMH, DJ (ret.)
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