ArticleAnnals of surgical oncology2026
Endocrine Therapy Omission in Estrogen Receptor-Low (1-10%) Early Stage Breast Cancer: An Updated Analysis of the NCDB Database.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndocrine therapy (ET) is recommended for estrogen receptor (ER)-positive breast cancer (BC), though its benefit in ER-low (1-10%) disease remains uncertain. Using the National Cancer Database (NCDB) from 2018 to 2020, we previously found that ET omission was associated with worse survival among 7018 patients with ER-low BC treated with (neo)adjuvant chemotherapy, with 586 deaths observed (Choong et al.). Herein, we evaluate ET omission and survival in an expanded NCDB cohort. PATIENTS AND
methodsFemale patients with stage I-III ER-low BC diagnosed between 2018 and 2023 and treated with neoadjuvant chemotherapy (NAC) and/or adjuvant chemotherapy were identified. Trends in ET use were assessed from 2018 to 2023, and overall survival (OS) was analyzed for patients diagnosed from 2018 to 2022. Kaplan-Meier methods estimated OS, and multivariable Cox regression evaluated associations between ET omission and mortality.
resultsAmong 12,983 patients, 8658 received NAC (53% achieved pathologic complete response [pCR]) and 4325 received adjuvant chemotherapy alone. ET use declined significantly over time (62% in 2018 versus 33% in 2023, p < 0.001), with the greatest decline among NAC-treated patients. OS analysis included 11,136 patients (median follow-up 3.4 years; 1137 deaths). ET omission was associated with worse OS (aHR 1.24, p < 0.001), particularly in patients with residual disease (RD) after NAC (aHR 1.23, p = 0.01). ET omission was associated with worse survival in both ER 1-5% and ER 6-10% subgroups.
conclusionsET use in ER-low BC treated with chemotherapy is declining. ET omission in ER-low BC treated with NAC with residual disease was associated with significantly worse overall survival.
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