Prioritizing breast cancer surgeries: insights from the KRONOS SCORE
IntroductionIn many healthcare systems, the time to surgery (TTS) is used as a quality measure in breast cancer (BC) care. Although guidelines suggest that a waiting period of up to four weeks is acceptable, this is often exceeded, potentially impacting treatment outcomes. The COVID-19 pandemic high...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1465154/full |
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| author | Lucía Navarro Lucía Navarro Lucía Navarro Luis Perez-Bartivas Luis Perez-Bartivas Luis Perez-Bartivas David Ponferrada David Ponferrada David Ponferrada Javier Cejas Javier Cejas Javier Cejas Juan Adrián Camús Juan Adrián Camús Juan Adrián Camús Natalia Rangel Natalia Rangel Natalia Rangel Maria Porras Cristina Morales Estevez Cristina Morales Estevez Cristina Morales Estevez Amalia Palacios Eito Amalia Palacios Eito Amalia Palacios Eito Pilar Rioja Pilar Rioja Pilar Rioja Marina Alvarez Marina Alvarez Marina Alvarez Enrique Aranda Enrique Aranda Enrique Aranda Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez |
| author_facet | Lucía Navarro Lucía Navarro Lucía Navarro Luis Perez-Bartivas Luis Perez-Bartivas Luis Perez-Bartivas David Ponferrada David Ponferrada David Ponferrada Javier Cejas Javier Cejas Javier Cejas Juan Adrián Camús Juan Adrián Camús Juan Adrián Camús Natalia Rangel Natalia Rangel Natalia Rangel Maria Porras Cristina Morales Estevez Cristina Morales Estevez Cristina Morales Estevez Amalia Palacios Eito Amalia Palacios Eito Amalia Palacios Eito Pilar Rioja Pilar Rioja Pilar Rioja Marina Alvarez Marina Alvarez Marina Alvarez Enrique Aranda Enrique Aranda Enrique Aranda Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez |
| author_sort | Lucía Navarro |
| collection | DOAJ |
| description | IntroductionIn many healthcare systems, the time to surgery (TTS) is used as a quality measure in breast cancer (BC) care. Although guidelines suggest that a waiting period of up to four weeks is acceptable, this is often exceeded, potentially impacting treatment outcomes. The COVID-19 pandemic highlighted the need to reassess surgical urgency. This study aims to explore the relationship between TTS and clinical outcomes in BC patients, focusing on how TTS influences final tumor stage and lymph node involvement.Materials and methodsA retrospective cohort study was conducted, including 924 women diagnosed with cT1-T3 BC without axillary lymph node involvement between 2014 and 2023. Preoperative staging was done using mammography and ultrasound, while postoperative staging relied on definitive anatomopathological reports. Statistical analyses included chi-square tests, Wilcoxon tests, and binary logistic regression. A prognostic score, the KRONOS SCORE, was developed based on significant variables from the final model, and internal validation was performed.ResultsOut of 924 patients, 781 had ductal carcinomas, 127 had lobular carcinomas, and 16 had other histologies. Breast-conserving surgery was performed on 664 patients, while 260 underwent mastectomy. TTS was less than 8 weeks for 513 patients and more than 8 weeks for 411 patients. No significant differences in tumor size changes were observed based on TTS. However, lymph node involvement increased from 23.8% in patients operated on within 8 weeks to 26.5% in those operated on after 8 weeks, with significant differences noted in poorly differentiated tumors (G3). The KRONOS SCORE, based on age, tumor grade, and size, was validated, showing a higher risk of lymph node involvement with higher scores.DiscussionAlthough TTS did not significantly affect most clinical and pathological parameters, a trend towards increased lymph node involvement with prolonged TTS was observed, particularly in patients with poorly differentiated tumors (G3). The KRONOS SCORE offers a tool for prioritizing surgical patients based on risk factors. However, further multicenter and prospective studies are needed to validate these findings and the KRONOS SCORE model’s effectiveness in different clinical settings. |
| format | Article |
| id | doaj-art-01d74fdfb7124188955a8ece2002e78c |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-01d74fdfb7124188955a8ece2002e78c2025-01-21T08:36:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011410.3389/fonc.2024.14651541465154Prioritizing breast cancer surgeries: insights from the KRONOS SCORELucía Navarro0Lucía Navarro1Lucía Navarro2Luis Perez-Bartivas3Luis Perez-Bartivas4Luis Perez-Bartivas5David Ponferrada6David Ponferrada7David Ponferrada8Javier Cejas9Javier Cejas10Javier Cejas11Juan Adrián Camús12Juan Adrián Camús13Juan Adrián Camús14Natalia Rangel15Natalia Rangel16Natalia Rangel17Maria Porras18Cristina Morales Estevez19Cristina Morales Estevez20Cristina Morales Estevez21Amalia Palacios Eito22Amalia Palacios Eito23Amalia Palacios Eito24Pilar Rioja25Pilar Rioja26Pilar Rioja27Marina Alvarez28Marina Alvarez29Marina Alvarez30Enrique Aranda31Enrique Aranda32Enrique Aranda33Juan De La Haba-Rodríguez34Juan De La Haba-Rodríguez35Juan De La Haba-Rodríguez36Medical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainBreast Cancer Surgery Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainRadiotherapy Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainBreast Cancer Radiology Department, University Hospital Reina Sofia, Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainBreast Cancer Surgery Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainBreast Cancer Radiology Department, University Hospital Reina Sofia, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainMedical Oncology Department, University Hospital Reina Sofia, Cordoba, SpainMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, SpainMedical School, University of Cordoba, Cordoba, SpainIntroductionIn many healthcare systems, the time to surgery (TTS) is used as a quality measure in breast cancer (BC) care. Although guidelines suggest that a waiting period of up to four weeks is acceptable, this is often exceeded, potentially impacting treatment outcomes. The COVID-19 pandemic highlighted the need to reassess surgical urgency. This study aims to explore the relationship between TTS and clinical outcomes in BC patients, focusing on how TTS influences final tumor stage and lymph node involvement.Materials and methodsA retrospective cohort study was conducted, including 924 women diagnosed with cT1-T3 BC without axillary lymph node involvement between 2014 and 2023. Preoperative staging was done using mammography and ultrasound, while postoperative staging relied on definitive anatomopathological reports. Statistical analyses included chi-square tests, Wilcoxon tests, and binary logistic regression. A prognostic score, the KRONOS SCORE, was developed based on significant variables from the final model, and internal validation was performed.ResultsOut of 924 patients, 781 had ductal carcinomas, 127 had lobular carcinomas, and 16 had other histologies. Breast-conserving surgery was performed on 664 patients, while 260 underwent mastectomy. TTS was less than 8 weeks for 513 patients and more than 8 weeks for 411 patients. No significant differences in tumor size changes were observed based on TTS. However, lymph node involvement increased from 23.8% in patients operated on within 8 weeks to 26.5% in those operated on after 8 weeks, with significant differences noted in poorly differentiated tumors (G3). The KRONOS SCORE, based on age, tumor grade, and size, was validated, showing a higher risk of lymph node involvement with higher scores.DiscussionAlthough TTS did not significantly affect most clinical and pathological parameters, a trend towards increased lymph node involvement with prolonged TTS was observed, particularly in patients with poorly differentiated tumors (G3). The KRONOS SCORE offers a tool for prioritizing surgical patients based on risk factors. However, further multicenter and prospective studies are needed to validate these findings and the KRONOS SCORE model’s effectiveness in different clinical settings.https://www.frontiersin.org/articles/10.3389/fonc.2024.1465154/fullbreast cancernode stagingclinical outcomestime to surgerylymph node metastasisneoplasm grading |
| spellingShingle | Lucía Navarro Lucía Navarro Lucía Navarro Luis Perez-Bartivas Luis Perez-Bartivas Luis Perez-Bartivas David Ponferrada David Ponferrada David Ponferrada Javier Cejas Javier Cejas Javier Cejas Juan Adrián Camús Juan Adrián Camús Juan Adrián Camús Natalia Rangel Natalia Rangel Natalia Rangel Maria Porras Cristina Morales Estevez Cristina Morales Estevez Cristina Morales Estevez Amalia Palacios Eito Amalia Palacios Eito Amalia Palacios Eito Pilar Rioja Pilar Rioja Pilar Rioja Marina Alvarez Marina Alvarez Marina Alvarez Enrique Aranda Enrique Aranda Enrique Aranda Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez Juan De La Haba-Rodríguez Prioritizing breast cancer surgeries: insights from the KRONOS SCORE Frontiers in Oncology breast cancer node staging clinical outcomes time to surgery lymph node metastasis neoplasm grading |
| title | Prioritizing breast cancer surgeries: insights from the KRONOS SCORE |
| title_full | Prioritizing breast cancer surgeries: insights from the KRONOS SCORE |
| title_fullStr | Prioritizing breast cancer surgeries: insights from the KRONOS SCORE |
| title_full_unstemmed | Prioritizing breast cancer surgeries: insights from the KRONOS SCORE |
| title_short | Prioritizing breast cancer surgeries: insights from the KRONOS SCORE |
| title_sort | prioritizing breast cancer surgeries insights from the kronos score |
| topic | breast cancer node staging clinical outcomes time to surgery lymph node metastasis neoplasm grading |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1465154/full |
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