Impact of major systemic postoperative infection on oncological outcomes after breast cancer surgery: a population based cohort study
Linda Adwall, Helena Sackey, Irma FredrikssonAbstract
Introduction
Major systemic infection following breast cancer surgery are associated with worse oncological outcomes. This study aimed to examine whether this association is explained by delays in adjuvant therapy. A secondary aim was to identify risk factors for developing major systemic infections.
Methods
This population-based cohort study comprised patients who underwent breast cancer surgery in Sweden between 2008 and 2019, identified through BCBaSe 3.0, a research database linking the Swedish National Quality Register for Breast Cancer with other national population-based healthcare and demographic registers. The primary exposure was major systemic infection occurring within 90 days of surgery. The primary endpoint was distant recurrence, while secondary endpoints included overall death, and breast cancer-specific death (BCSD).
Results
Of the 80 912 patients included in the cohort, 1.8% (n = 1458) developed a major systemic infection within 90 days. After adjustment for confounders, among exposed patients, time to chemotherapy was not associated with distant recurrence (HR 1.00, 95% c.i. 0.98–1.02), overall death (HR 1.00, 95% c.i. 0.98–1.01), or BCSD (HR 1.00, 95% c.i. 0.98–1.02). However, among those who received radiotherapy (RT), prolonged time to RT initiation was associated with distant recurrence (HR 1.04, 95% c.i. 1.01–1.07), whereas no associations were observed for overall death or BCSD.
Discussion
Chemotherapy delays did not account for the poorer outcomes observed after major systemic infection. The association between longer time to RT and higher distant recurrence risk underscores the need to prevent major infections and maintain timely delivery of adjuvant therapy.