Impact of Multidisciplinary Team Discussion on Treatment Decision-Making and Survival in Early-Stage HR+/HER2-Breast Cancer

Impact of Multidisciplinary Team Discussion on Treatment Decision-Making and Survival in Early-Stage HR+/HER2-Breast Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Multidisciplinary Team Discussion on Treatment Decision-Making and Survival in Early-Stage HR+/HER2-Breast Cancer Lingli Yao, Jiayi Yu, Qingqing He, Dan Ye, Jiabo Zhang, Jiali Yang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8499154/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background Multidisciplinary teams (MDTs) have been shown to improve breast cancer outcomes. This study aimed to examine the effect of MDT on therapeutic decision-making for breast cancer (BCA) patients, particularly in the subtype of early-stage HR+/HER2-BCA. Methods We analyzed 472 breast cancer patients who were first diagnosed at our institution between 1 January, 2020, and 31 January, 2022. The clinicopathological features were obtained from medical records. Patients were assigned to two groups on the basis of whether their cases were discussed at the MDT. Propensity score matching (1:1) generated 140 well-balanced cases in the early-stage HR+/HER2- subgroup. Cox regression and chi-square tests were used to evaluate survival and treatment differences. Results The results of Cox regression revealed that better DSS was associated with MDT (YES vs NO; HR = 0.292, CI: 0.096–0.887, P = 0.030), HR Status (Positive vs Negative) ; HR = 0.066, CI: 0.015–0.212, P < 0.001), and a lower Stage (I vs II, HR = 0.005, CI:0.000-0.053, P < 0.001; I vs III, HR = 0.003, CI: 0.000-0.043, P < 0.001,I vs IV, HR = 0.053, CI: 0.004–0.703, P = 0.026). The rates of 2- and 3-year regular follow-up in the MDT group were greater than those in the observed group (92.9% vs 86.9%, P = 0.028; 90.2% vs 82.3%, P = 0.012). In the subgroup, MDT integration significantly increased chemotherapy utilization (42.9% vs 40.0%) while reducing aggressive EC-T regimens (5.7% vs 21.4%, P = 0.005). MDT was associated with increased use of 21-gene test and ovarian function suppression (OFS) in this subgroup (20.0% vs 7.1%, P = 0.026). Conclusions MDT discussion was associated with more precise treatment strategies in HR+/HER2- breast cancer, as evidenced by increased use of genomic testing, chemotherapy de-escalation, and improved long-term follow-up adherence. multidisciplinary team quality breast cancer survival Figures Figure 1 Introduction Breast cancer (BCA) remains the most prevalent cancer among women worldwide, accounting for 2.2 million new cases and over 660,000 deaths annually[1]. BCA can be classified into different molecular subtypes with varying clinical and pathological characteristics to aid in diagnosis, prognosis, and treatment[2–4]. Although molecular subtyping based on immunohistochemistry (IHC) has guided treatment decisions, IHC has several limitations[5], approximately 30% of cases show IHC-genomic discordance[6]. This discordance is particularly prominent in hormone receptor (HR) positive/HER2 negative tumors[7], where conventional biomarkers may fail to accurately predict recurrence risk and therapeutic response. Multidisciplinary team (MDT) approaches have demonstrated substantial benefits in breast cancer management, enhance diagnostic accuracy, optimize treatment sequencing, reduce unnecessary procedures, shorten diagnostic wait times, and improve survival and quality of life [8, 9]. Critically, MDT can identify patients who might benefit from either treatment escalation or de-escalation, thereby enabling therapy to be tailored more precisely to individual risk profiles. However, the specific impact of MDT decisions on therapeutic strategies for patients with discordant IHC and genomic results remains underexplored. This study specifically focuses on patients with early-stage, HR+/HER-2-breast cancer which exhibiting discrepancies between IHC classification and genomic risk assessment[10, 11]. We hypothesize that MDT recommendations significantly alter adjuvant therapy recommendations (chemotherapy, endocrine therapy intensity and duration) for this discordant population compared to decisions made based on standard clinicopathological factors alone, leading to more personalized risk-adapted therapy. The primary aims of this study are to quantify the frequency and direction (escalation vs. de-escalation) of changes in adjuvant therapy recommendations resulting from MDT review for patients in the subgroup. By directly comparing MDT and non-MDT management and dissecting treatment patterns within the critical discordant luminal subgroup, this study aims to provide robust evidence on how MDT alters therapeutic pathways and optimizes care for this complex patient population. Methods Ethical Oversight The Research Ethics Board of our institution approved this retrospective single-institution study (Approval number: NO.039RS-01). Inclusion and exclusion criteria The study examined patients diagnosed with breast cancer at our institution between 1 January, 2020, and 31 January, 2022. Follow-up data were censored on November 30, 2024. The inclusion criteria for the study were as follows: (1) Pathologically confirmed invasive or non-invasive breast cancer; (2) Newly diagnosed at our institution between January 1, 2020, and January 31, 2022; and (3) Age ≥ 18 years; (4) Complete clinicopathological data (including estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67, grade, and stage); (5) Female. Exclusion Criteria: (1) Incomplete data (missing key biomarkers, treatment records, or follow-up data). (2) Prior history of breast cancer. (3) Prior history of active malignancy, except Non-melanoma skin cancer and malignancies cured ≥ 5 years prior to breast cancer diagnosis. Data Collection The data collected included demographic information (e.g., age at BCA diagnosis, sex, menopausal status, and personal and family medical history). Clinical staging information (AJCC and TNM), histology type, Scarff-Bloom Richardson tumor grade, and immunohistochemically determined ER, PR, and HER2 receptor status data were collected from the tumor samples. First immunohistochemistry results were recorded if patients had received neoadjuvant therapy. In addition, clinical follow-up and treatment methods (surgical procedures, radiation, endocrine therapy, and adjuvant chemotherapy) were obtained from medical records. Molecular Subtyping Definitions We defined tumors as ER or PR positive when their expression was ≥ 1%. Tumors were classified as HER-2 positive if the immunohistochemistry (IHC) survey showed a score of 3 + or if fluorescence in situ hybridization (FISH) indicated a HER2/CEP17 ratio of ≥ 2. Patients were assigned to two groups based on whether their cases were discussed at a multidisciplinary meeting. IHC-genomic discordance: In HR+/HER2 − breast cancer, genomic recurrence risk was stratified using the TAILORx trial criteria. High genomic risk: 21-gene Recurrence Score (RS) ≥ 26 (indicating chemotherapy benefit), intermediate genomic risk: RS 11–25, low genomic risk: RS ≤ 10[12, 13]. Molecular subtyping by immunohistochemistry followed the St. Gallen International Expert Consensus guidelines. Subgroups: Early-stage HR+/HER2- breast cancer patients: (1) patients diagnosed with invasive breast cancer, (2) patients with stage I-II breast cancer, and (3) patients who were HR positive and HER-2 negative according to IHC. MDT MDT met every 7 days, and the participating physicians had the following disciplines: surgical, radiation, medical, interventional radiology, pathology, and ultrasound specialist. While all patients were eligible for MDT review, referrals were typically initiated by treating physicians based on clinical complexity, discordant biomarker results, or ambiguous risk stratification. Statistical analysis Categorical variables were compared using Fisher's exact test or Pearson's χ² test, as appropriate (Fisher's test for expected cell counts < 5). Continuous variables were analyzed with Student's t-test for normally distributed data or Mann-Whitney U test for non-parametric data. Multivariable Cox proportional hazards models were constructed to adjust for clinically relevant covariates. Multivariable Cox regression analysis was performed for DSS of invasive breast cancer. Hazard ratios (HRs) with 95% confidence intervals (CIs) and P -values were reported. Propensity score matching (1:1) was applied to balance baseline characteristics, Standardized Mean Difference (SMD) < 0.1. To account for variable follow-up times and avoid immortal time bias, our survival analyses rigorously adhered to the principles of right-censoring. Time-zero was defined as the date of initial pathological diagnosis. Patients were right-censored at the date of their last documented clinical follow-up if they were without evidence of disease-related event (for Disease Specific Survival, DSS) by the study's data closure date (November 30, 2024). This approach ensures that all patients contribute person-time to the analysis only for the duration they were under active observation. To ensure that differences in outcomes were not artifactual due to unequal follow-up, we formally compared the distribution of follow-up times between the MDT and non-MDT cohorts. As follow-up time was non-normally distributed, the Mann-Whitney U tes t (for two-group comparison) was employed. All the statistical analyses were performed with SPSS software (version 22.0), with visualization in GraphPad Prism (version 8.0). Statistical significance was set at a two-sided P < 0.05. Results Table 1 Clinical characteristics of 472 breast cancer patients Characteristics Total No% Age years Median(range) 53(25,86) Menopause Premenopause 200(42.4) Postmenopause 272(57.6) History Of Malignancy YES 43(9.1) NO 429(90.9) Clinical Stage I 271(57.4) II 137(29.1) III 61(12.9) IV 3(0.6) US-guided vacuum-assisted biopsy before surgery YES 96(20.3) NO 376(79.7) Breast-Conserving YES 161(34.1) NO 311(65.9) SLNB YES 329(69.7) NO 143(30.3) ALND YES 183(38.8) NO 289(61.2) Receive Neoadjuvant therapy YES 26(5.5) NO 446(94.5) Immunohistochemical type HR+/HER2- 285(60.4) HR+/HER2+ 48(10.2) HR-/HER2+ 67(14.2) HR-/HER2- 72(15.2) MDT YES 297(62.9) NO 175(37.1) 21 Gene test 23 Accordant with IHC 14(60.9) Disaccordant with IHC 9(39.1) ET YES 323(68.4) NO 149(31.6) Chemotherapy YES 295(62.5) NO 177(37.5) Radiotherapy YES 225(47.7) NO 247(52.3) NOTE: SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; MDT, multidisciplinary team; ET, endocrine therapy. A total of 472 patients were included in this study. Median follow-up was 38.6 months (IQR 10.7 to 56.8 months), with no difference between cohorts (MDT group: 38.2 months vs. observed group: 39.2 months, P = 0.405). The median age of the patients was 53 years (range 25 to 86 years). Among the female patients, 200 (42.4%) were premenopausal, and 272 (57.6%) were postmenopausal. 9.1% of patients had a history of malignancy. A total of 271 (57.4%) and 137 (29.1%) patients were in stages I and II, respectively. A total of 96 (20.3%) patients underwent US-guided vacuum-assisted biopsy before curative surgical resection under local anesthesia. Only 26 (5.5%) patients received neoadjuvant therapy. A total of 161 (34.1%) patients received breast-conserving surgery. The rates of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) were 69.7% and 38.8%, respectively (Table 1 ). Among 23 patients who underwent 21-gene recurrence score testing, 9 (39.1%) exhibited IHC-genomic risk discordance based on predefined St. Gallen vs. TAILORx criteria. The most common IHC subtype is HR positive /HER-2 negative (60.4%). The HR negative/HER-2 positive and HR negative/HER-2 negative subtypes accounted for only 14.2% and 15.2%, respectively. A total of 323 (68.4%) patients received endocrine therapy (ET), 297 (62.9%) patients received chemotherapy, and 227 (48.1%) patients received radiotherapy. NOTE: LVI Lymphovascular Invasion; DSS, Disease Specific Survival According to the multivariate Cox regression analysis of DSS for invasive breast cancer patients, significantly better DSS was associated with MDT (YES vs NO; HR = 0.292, CI: 0.096–0.887, P = 0.030), HR positive Status (Positive vs Negative) ; HR = 0.066, CI: 0.015–0.212, P < 0.001), and a lower Stage (ⅠvsⅡ, HR = 0.005, CI:0.000-0.053, P < 0.001; Ⅰvs Ⅲ, HR = 0.003, CI: 0.000-0.043, P < 0.001,Ⅰvs Ⅳ, HR = 0.053, CI: 0.004–0.703, P = 0.0.026, Fig. 1 ). Table 2 Table 2 . Comparative analysis of MDT (n = 297) vs Observed group (n = 175) cohorts Characteristics MDT group Observed group χ ² P value Age, years Median (range) 52.0(25,85) 55.5(32,86) ≤ 45 60(20.2) 21(12.0) 5.211 0.022 > 45 237(79.8) 154(88.0) Menopause YES 158(53.2) 114(65.1) 6.434 0.011 NO 139(46.8) 61(34.9) History of malignancy YES 26(8.8) 17(9.7) 0.123 0.726 NO 271(91.2) 158(90.3) AJCC-Stage 0 10(3.4) 22(12.6) 18.028 0.001 Ⅰ 169(56.7) 79(45.1) Ⅱ 80(26.8) 50(28.6) Ⅲ 38(12.8) 22(12.6) Ⅳ 1(0.3) 2(1.1) Breast-conserving YES 107(36.0) 54(30.9) 1.309 0.252 NO 190(64.0) 121(69.1) SLNB YES 204(68.7) 125(71.4) 0.392 0.531 NO 93(31.3) 50(28.6) ALND YES 118(39.7) 65(37.1) 0.311 0.577 NO 179(60.3) 110(62.9) Neoadjuvant therapy YES 13(4.4) 13(7.4) 1.970 0.160 NO 284(95.6) 162(92.6) Endocrine therapy YES 205(69.0) 118(67.4) 0.130 0.719 NO 92(31.0) 57(32.6) Chemotherapy YES 199(67.0) 96(54.9) 6.931 0.008 NO 98(33.0) 79(45.1) Radiotherapy YES 158(53.2) 67(38.3) 9.817 0.002 NO 139(46.8) 108(61.7) Pathology DCIS 19(6.4) 29(16.6) 18.968 0.002 IDC 245(82.6) 139(73.7) ILC 9(3.0) 7(4.0) CC 9(3.0) 4(2.3) PC 6(2.0) 6(3.4) Others 9(3.0) 0 Immunohistochemical type HR+/HER2- 175(58.9) 110(62.9) 1.153 0.764 HR+/HER2+ 33(11.1) 15(8.5) HR-/HER2+ 42(14.2) 25(14.3) HR-/HER2- 47(15.8) 25(14.3) 1year Regular follow-up checks YES 282(94.9) 165(94.3) 0.097 0.756 NO 15(5.1) 10(5.7) 2year Regular follow-up checks YES 276(92.9) 152(86.9) 4.803 0.028 NO 21(7.0) 23(13.1) 3year Regular follow-up checks YES 268(90.2) 144(82.3) 6.272 0.012 NO 29(9.8) 31(17.7) Patients were grouped based on whether they were discussed at the MDT; 297 patients were in the MDT group, and 175 patients were in the observed group. Statistical comparisons between groups revealed significant differences in age, menopause status, AJCC stage, chemotherapy, radiotherapy, pathology, and 2 and 3 years of regular follow-up. The MDT group had a median age (range) of 52.0 years (25, 85). In the observed group, the median age (range) of the patients was 55.5 years (32, 86). Compared with those in the observed group, patients in the MDT group were younger, with more patients aged 45 years and younger (20.2% vs 12.0%, P = 0.022) and a greater number of premenopausal patients (46.8% vs 34.9%, P = 0.011), Table 2 . There were no statistically significant differences detected in surgical categories (breast-conserving surgery, 36.0% vs 30.9%, P = 0.252; SLNB, 68.7% vs 71.4%, P = 0.531; and axillary dissection, 39.7% vs 37.1%, P = 0.577). The results of the pathological type analysis revealed a greater proportion of carcinoma in situ (29,16.6%). Therefore significant differences were observed in the AJCC stage ( P = 0.001). In addition, a comparison of immunohistochemical type revealed no significant difference between the two groups ( P = 0.764, Table 2 ), either receiving ET ( P = 0.719, Table 2 ). Patients in the MDT group were more likely to receive chemotherapy and radiation (67.0% vs 54.9%, P = 0.017; 53.2% vs 38.3%, P = 0.001). Although first-year follow-up rates were slightly higher in the MDT group, the difference was not statistically significant (94.9% vs 94.3%, P = 0.756). The MDT group showed superior 3-year follow-up adherence (90.2% vs 82.3%, P = 0.012), with absolute increases of 6.0% (Year 2) and 7.9% (Year 3). Table 3 Treatment patterns in propensity-matched HR+/HER2- cohort (n = 140) Characteristics MDT group Observe group χ ² P value 21gene YES 14(20.0) 5(7.1) 4.933 0.026 NO 56(80.0) 65(92.9) Chemotherapy EC4-T4 4(5.7) 15(21.4) 10.751 0.005 EC4/TC4-6 26(37.2) 13(18.6) NO 40(57.1) 42(60.0) OFS OFS + SERM/AI 14(20.0) 5(7.1) 4.933 0.026 SERM/AI 56(80.0) 65(92.9) Radiotherapy Patient refusal 8(11.4) 10(14.3) 0.319 0.956 clinically indicated omission 37(52.9) 37(52.9) Intensified radiotherapy 17(24.3) 16(22.8) RNI 8(11.4) 7(10.0) NOTE: EC4-T4: Epirubicin plus Cyclophosphamide for 4 cycles followed by Taxotere for 4 cycles; EC4: Epirubicin plus Cyclophosphamide for 4 cycles; TC 4–6: Taxotere plus Cyclophosphamide for 4 to 6 cycles. OFS: Ovarian function suppression; SERM: Selective Estrogen Receptor Modulator, AI: Aromatase Inhibitors, RNI: regional nodal irradiation. A total of 215 cases with HR+/HER2-negative stage I–II breast cancer were identified from the initial cohort of 472 patients. Propensity score matching (1:1) was applied to balance baseline characteristics, including menopausal status, breast-conserving, and lymph node involvement. This generated 140 well-matched cases, with all SMD below 0.1, indicating adequate covariate balance. A significantly greater proportion of MDT-managed patients underwent 21-gene assay testing (20.0%) than controls (7.1%, P = 0.026). A total of 37.1% of patients in the MDT group received TC or EC, 57.1% did not receive any chemotherapy, 18.6% of those in the observed group received TC or EC, and 60.0% did not receive any chemotherapy. Notably, the EC-T regimen was administered significantly more frequently in the observed group (21.4% [15/70]) than in the MDT group (5.7% [4/70], P < 0.005, Table 3 ). In addition, a greater percentage of patients in the MDT group received ovarian function suppression (OFS) combined with TAM or EXE (20.0% vs 7.1%, P < 0.05). Radiotherapy omission rates were identical across groups (52.9% in both arms), primarily driven by guideline-concordant indications for radiotherapy avoidance. Patient refusal rates were numerically lower in the MDT cohort (11.4% vs 14.3%). MDT cases showed marginally higher utilization of dose-escalated radiotherapy and comprehensive regional nodal irradiation (RNI). Discussion Breast cancer is a biologically heterogeneous disease comprising distinct molecular subtypes that necessitate divergent therapeutic pathways. This complexity underscores the critical role of MDT approaches in integrating surgical, systemic, and radiation therapies to optimize oncological outcomes while preserving quality of life. MDT approaches enhance staging precision and optimize treatment selection for upper gastrointestinal malignancies, as evidenced in gastric and esophageal cancers[14]. Robust evidence confirms MDT-associated survival benefits across malignancies[15, 16]. In a propensity-matched analysis by Tsai et al., MDT-managed patients demonstrated significantly reduced recurrence risk (HR = 0.84, 95% CI: 0.70–0.99) [17]. In our study, receiving MDT associated with better DSS (HR = 0.292, CI: 0.096–0.887, P = 0.030). Similarly, Xu et al. reported superior overall survival in MDT-managed breast cancer patients with brain metastases compared to non-MDT controls (OS: 34.2 months vs 8.2 months). Despite these advances, the impact of MDT decision-making on therapeutic strategies for biologically discordant luminal tumors, where IHC classification conflicts with genomic risk profiling, remains poorly characterized, forming the rationale for our investigation. Our study extends this paradigm by demonstrating MDT's critical role in resolving therapeutic uncertainty for biomarker-discordant cases. In this study, among the 23 patients who underwent 21-gene assay 39.1% (9/23) exhibited discordance between genomic risk stratification and conventional IHC classification, precisely the scenario where standard biomarkers fail to guide appropriate therapy. Our findings reveal significant divergence in treatment decision-making between the MDT and observe cohorts. The absolute difference in overall chemotherapy utilization (42.9% in MDT vs. 40.0% in controls, P = 0.72) was indeed not statistically significant. However, there is a significant 15.7% absolute reduction in the use of aggressive, anthracycline-based regimens (EC-T: 5.7% in MDT vs. 21.4% in controls, P = 0.005). The marked reduction in EC-T use underscores the role of MDT in de-escalating therapy for patients unlikely to benefit from more toxic regimens, thereby avoiding unnecessary side effects (e.g., cardiotoxicity, secondary malignancies) without compromising survival. The significant reduction in aggressive EC-T regimens, despite similar overall chemotherapy rates, suggests that MDT discussion shifted treatment patterns towards less toxic options for selected patients. This may reflect a more nuanced interpretation of individual patient risk, potentially aided by the higher utilization of the 21-gene assay (20.0% vs. 7.1%, P = 0.026), which provides a more precise recurrence risk estimate than IHC alone. In summary, while the overall propensity to give chemotherapy was similar between groups, the MDT's impact was to re-allocate patients to more appropriate, risk-stratified regimens. This represents a highly clinically meaningful improvement in the quality of decision-making, moving away from a one-size-fits-all approach towards precision medicine. B aseline characteristics revealed expected selection biases: MDT cohort exhibited higher proportions of younger patients (median age 52.0 vs 55.5, P = 0.022), and age ≤ 45 years(20.2% vs 12.0%, P = 0.011), consistent with clinical prioritization of high-risk demographics for multidisciplinary evaluation. Although AJCC stage distribution differed significantly ( P = 0.001), this disparity was predominantly driven by a higher proportion of Stage 0 (DCIS) cases in the non-MDT group (12.6% vs 3.4%). Surgical management demonstrated homogeneity between cohorts (breast-conserving surgery: 36.0% vs 30.9%; SLNB: 68.7% vs 71.4%; ALND: 39.7% vs 37.1%; all P > 0.1), attributable to surgeries occurring prior to MDT referral. This highlights a critical limitation in assessing MDT's surgical impact within current care pathways. The null surgical findings contrast with MDT-associated increases in breast conservation reported by Kesson et al[18], likely reflecting temporal discordance between surgical decisions and MDT review in our cohort. This highlights the need for prospective evaluation of preoperative MDT models for biomarker-discordant cases, particularly where genomic risk profiles could influence surgical planning, avoidance of axillary dissection in genomic-low cN1 disease. While MDT participation was influenced by age and stage, its survival benefit persisted after risk adjustment via PSM and multivariable regression (in supplementary TableS2 and Table S3). This suggests outcome improvements are primarily attributable to MDT driven decision-making, not to selection bias. Although statistical significance was not achieved, the directional trends toward reduced treatment refusal and increased utilization of precision radiotherapy techniques in the MDT cohort merit further investigation in larger cohorts. While our initial data showed higher RT rate in MDT managed patients (53.9% vs 38.3%, P = 0.002), our risk-adjusted analysis revealed critical nuances: after controlling for nodal status and surgical approach (breast conservation), the initial 15.6% absolute reduction in RT omission lost statistical significance. This paradox suggests that the observed RT utilization gap may stem from three latent factors: MDT groups included more high-risk cases requiring RT, as MDT protocols often prioritize complex presentations. When risk-stratified, comparable-stage patients received RT at similar rates. After adjusting for clinicopathological factors, the initial difference in radiotherapy rates was attenuated, indicating that the decision for radiotherapy was primarily guided by established clinical guidelines rather than being significantly altered by MDT review alone Gl obal data contextualize these findings: RT omission rates range from 7–25% across healthcare systems[19–21], with MDT-discordant implementation occurring in 7–16% of cases[22, 23]. Crucially, Bortot et al.[23]demonstrated that 72% of deviations stemmed from patient preferences, highlighting MDT's unrealized potential for shared decision-making in adjuvant therapy. While our MDT cohort showed no statistical RT utilization advantage, its 20% relative reduction in treatment refusal (11.4% vs 14.3%). In early-stage HR+/HER2- breast cancer, optimizing disease-free survival (DFS) while minimizing overtreatment remains paramount. The 21-gene recurrence score (RS) assay provides prognostic refinement beyond clinicopathological factors, guiding chemotherapy decisions[24, 25]. Our analysis demonstrates that MDT integration significantly increased chemotherapy utilization (2.9% absolute difference; 42.9% vs 40.0%) while reducing aggressive EC-T regimens (5.7% vs 21.4%, P = 0.005). This shift toward precision therapy reflects MDT's capacity to identify recurrence risk through multidimensional assessment, particularly valuable when genomic testing is precluded by socioeconomic barriers. Treatment selection patterns further validated guideline-concordant de-escalation. Our findings demonstrate a pivotal role of MDT in optimizing endocrine therapy intensification for high-risk premenopausal patients. The MDT cohort exhibited significantly higher utilization of ovarian function suppression (OFS) combined with tamoxifen or aromatase inhibitors (20.0% vs 7.1%, P = 0.026), translating to a 2.8-fold increase in guideline-concordant care. For high-risk premenopausal patients, antiestrogen plus ovarian function suppression (OFS), such as the administration of gonadotropin-releasing hormone analogs (aLHRH) plus exemestane or tamoxifen can increase DFS [26]. However, the absence of DFS benefit in our median 3.2-year follow-up mirrors SOFT's early data, cautioning against OFS overuse in intermediate-risk cases. MDT's value lies in distinguishing true SOFT high-risk (OFS essential) from TEXT intermediate-risk (consider chemo instead). Beyond survival and treatment optimization, a key practical benefit of the MDT-coordinated pathway was a significant improvement in long-term surveillance adherence. NCCN proposes clinical follow-up with medical history and physical examination every three months during the first 2–3 years[27]. A key practical benefit demonstrated by the MDT-coordinated pathway was a significant improvement in 3-year follow-up adherence (90.2% vs 82.3%, P = 0.012). The enhancement likely stems from MDT's structured closing-the-loop systems: 1) Centralized tracking, 2) Patient navigators, 3) Multidisciplinary survivorship plans. By ensuring more patients complete their recommended surveillance schedule during the critical peak recurrence window (Years 2–3 post-diagnosis), the MDT model creates vital opportunities for earlier detection of recurrence and more timely intervention. This directly addresses identified attrition risks, older age at diagnosis, tumor stage, and no prior receipt of radiation, chemotherapy, or endocrine therapy were risk factors for loss to follow-up[28, 29]. To our knowledge, this is one of the few studies to quantitatively assess the impact of MDT on systematic impact on chemotherapy de-escalation in luminal breast cancer. The observed 3.4-fold increase in 21-gene testing utilization and 14.4% absolute reduction in anthracycline-based chemotherapy. These findings substantiate MDT's role in resolving therapeutic ambiguity when IHC and genomic risk diverge. Limitations While this study provides insights into MDT impacts, several limitations warrant discussion. First, the single-center, retrospective design may limit the generalizability of our findings to other institutions with different patient demographics or healthcare practices. Second, the retrospective nature introduces potential biases in data collection and analysis, as it relies on existing medical records, which may be incomplete or inconsistent. And evolving treatment guidelines during the study period could confound outcome comparisons, as later cases may have benefited from updated therapies. Thirdly, the relatively small sample size may reduce the statistical power and limit the ability to detect significant differences or rare outcomes. Residual confounding may persist despite propensity matching, as variables like comorbidities or genetic risk factors were unavailable in registry data. Fourth, the number of patients who underwent the 21-gene recurrence score assay in our cohort was relatively small (n = 23), which limits the generalizability of our findings regarding IHC-genomic discordance and precluded a more robust statistical analysis of this specific subgroup. This was primarily due to the high cost of the test and its selective reimbursement policy in our healthcare system during the study period, which restricted its application to only the most complex or ambiguous cases. However, it is noteworthy that even within this small, select group, the rate of discordance was substantial (39.1%), highlighting the clinical relevance of this scenario and the potential value of MDT in addressing it. Future prospective studies with pre-specified universal genomic testing are warranted to definitively assess the impact of MDT on biomarker-discordant populations. These limitations highlight the need for future prospective, multicenter studies to validate and expand upon our findings. Multicenter, prospective studies are necessary to validate our conclusions. Declarations Ethics approval and consent to participate This retrospective study was approved by the Institutional Ethics Committee of The First Affiliated Hospital of Ningbo University (Approval number: NO.039RS-01), with waiver of informed consent. All procedures performed in this study were conducted in accordance with the Declaration of Helsinki. Consent for publication All authors approved the publication of this version. Availability of data and materials Please send requests to access this dataset to the author, Dr. Yao. ( [email protected] ). Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Not applicable. Authors' contributions Lingli Yao: Conceptualized the study, performed data analysis, and drafted the manuscript. Jiayi Yu : Conducted primary data collection. Qingqing He: Designed statistical methodologies and performed data validation. Dan Ye: Prepared Tables 1 and 2. Dongbo Shi and Yu Guo: Contributed to the initial study design and intellectual content. Jiali Yang for proofreading the manuscript Acknowledgement Not applicable. 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Tarantino, P., et al., Comprehensive genomic characterization of HER2-low and HER2-0 breast cancer. Nat Commun, 2023. 14 (1): p. 7496. Prades, J., et al., Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy, 2015. 119 (4): p. 464-74. Akhtar, Z., et al., The effect of 1-day multidisciplinary clinic on breast cancer treatment. Breast Cancer Res Treat, 2020. 182 (3): p. 623-629. Lashen, A., et al., Evaluation oncotype DX(®) 21-gene recurrence score and clinicopathological parameters: a single institutional experience. Histopathology, 2023. 82 (5): p. 755-766. Han, R., et al., Oncotype DX recurrence score in node-positive patients in the post-RxPONDER era: a single-institution experience. Breast Cancer Res Treat, 2025. 211 (2): p. 449-454. Sparano, J.A., et al., Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med, 2018. 379 (2): p. 111-121. Koh, M., et al., Prognostic value of the 21-gene recurrence score for regional recurrence in patients with estrogen receptor-positive breast cancer. Breast Cancer Res Treat, 2021. 188 (3): p. 583-592. Luijten, J.C.H.B.M., et al., Team dynamics and clinician’s experience influence decision-making during Upper-GI multidisciplinary team meetings: A multiple case study. 2022. 12 . Kesson, E.M., et al., Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. Bmj, 2012. 344 : p. e2718. Stirling, R.G., et al., Multidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis. Eur Respir Rev, 2024. 33 (172). Tsai, C.H., et al., Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast, 2020. 53 : p. 68-76. Fancellu, A., et al., The importance of the multidisciplinary team in the decision-making process of patients undergoing neoadjuvant chemotherapy for breast cancer. Updates Surg, 2024. 76 (5): p. 1919-1926. Liu, J., et al., Radiotherapy refusal in breast cancer with breast-conserving surgery. Radiat Oncol, 2023. 18 (1): p. 130. Yu, J.I., et al., Proportion and clinical outcomes of postoperative radiotherapy omission after breast-conserving surgery in women with breast cancer. J Breast Cancer, 2015. 18 (1): p. 50-6. Tuttle, T.M., et al., Omission of radiation therapy after breast-conserving surgery in the United States: a population-based analysis of clinicopathologic factors. Cancer, 2012. 118 (8): p. 2004-13. Ichikawa, M., et al., Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: an observational study at a single Japanese institution. BMC Med Inform Decis Mak, 2022. 22 (1): p. 111. Bortot, L., et al., Multidisciplinary Team Meeting Proposal and Final Therapeutic Choice in Early Breast Cancer: Is There an Agreement? Front Oncol, 2022. 12 : p. 885992. Copson, E.R., et al., Expert UK consensus on the definition of high risk of recurrence in HER2-negative early breast cancer: A modified Delphi panel. Breast, 2023. 72 : p. 103582. Zhang, Y., et al., Ki-67 index, progesterone receptor expression, histologic grade and tumor size in predicting breast cancer recurrence risk: A consecutive cohort study. Cancer Commun (Lond), 2020. 40 (4): p. 181-193. Pagani, O., et al., Absolute Improvements in Freedom From Distant Recurrence to Tailor Adjuvant Endocrine Therapies for Premenopausal Women: Results From TEXT and SOFT. J Clin Oncol, 2020. 38 (12): p. 1293-1303. Gradishar, W.J., et al., Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2024. 22 (5): p. 331-357. Kukar, M., et al., Fostering coordinated survivorship care in breast cancer: who is lost to follow-up? J Cancer Surviv, 2014. 8 (2): p. 199-204. Ruddy, K.J., et al., Follow-up Care for Breast Cancer Survivors. J Natl Cancer Inst, 2020. 112 (1): p. 111-113. Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers invited by journal 14 Jan, 2026 Editor assigned by journal 08 Jan, 2026 Submission checks completed at journal 04 Jan, 2026 First submitted to journal 02 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":160231,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMultivariable Cox regression analysis of DSS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNOTE: LVI Lymphovascular Invasion; DSS, Disease Specific Survival\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8499154/v1/4f6a1fce8131c17ba4871ecb.png"},{"id":100597741,"identity":"81eeb994-c6dc-4094-81ac-436642a56f37","added_by":"auto","created_at":"2026-01-19 14:20:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1568460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8499154/v1/fdd87a80-65eb-44f2-8762-82f6d17063aa.pdf"},{"id":100567698,"identity":"81ed704b-6bf0-418c-a9f0-3254b887d4f3","added_by":"auto","created_at":"2026-01-19 09:13:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":40099,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-8499154/v1/ecf00fe89d3f14d50622d1ed.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Multidisciplinary Team Discussion on Treatment Decision-Making and Survival in Early-Stage HR+/HER2-Breast Cancer\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer (BCA) remains the most prevalent cancer among women worldwide, accounting for 2.2\u0026nbsp;million new cases and over 660,000 deaths annually[1]. BCA can be classified into different molecular subtypes with varying clinical and pathological characteristics to aid in diagnosis, prognosis, and treatment[2\u0026ndash;4]. Although molecular subtyping based on immunohistochemistry (IHC) has guided treatment decisions, IHC has several limitations[5], approximately 30% of cases show IHC-genomic discordance[6]. This discordance is particularly prominent in hormone receptor (HR) positive/HER2 negative tumors[7], where conventional biomarkers may fail to accurately predict recurrence risk and therapeutic response.\u003c/p\u003e \u003cp\u003eMultidisciplinary team (MDT) approaches have demonstrated substantial benefits in breast cancer management, enhance diagnostic accuracy, optimize treatment sequencing, reduce unnecessary procedures, shorten diagnostic wait times, and improve survival and quality of life [8, 9]. Critically, MDT can identify patients who might benefit from either treatment escalation or de-escalation, thereby enabling therapy to be tailored more precisely to individual risk profiles. However, the specific impact of MDT decisions on therapeutic strategies for patients with discordant IHC and genomic results remains underexplored.\u003c/p\u003e \u003cp\u003eThis study specifically focuses on patients with early-stage, HR+/HER-2-breast cancer which exhibiting discrepancies between IHC classification and genomic risk assessment[10, 11]. We hypothesize that MDT recommendations significantly alter adjuvant therapy recommendations (chemotherapy, endocrine therapy intensity and duration) for this discordant population compared to decisions made based on standard clinicopathological factors alone, leading to more personalized risk-adapted therapy.\u003c/p\u003e \u003cp\u003eThe primary aims of this study are to quantify the frequency and direction (escalation vs. de-escalation) of changes in adjuvant therapy recommendations resulting from MDT review for patients in the subgroup. By directly comparing MDT and non-MDT management and dissecting treatment patterns within the critical discordant luminal subgroup, this study aims to provide robust evidence on how MDT alters therapeutic pathways and optimizes care for this complex patient population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eEthical Oversight\u003c/p\u003e \u003cp\u003e The Research Ethics Board of our institution approved this retrospective single-institution study (Approval number: NO.039RS-01).\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e \u003cp\u003eThe study examined patients diagnosed with breast cancer at our institution between 1 January, 2020, and 31 January, 2022. Follow-up data were censored on November 30, 2024.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for the study were as follows: (1) Pathologically confirmed invasive or non-invasive breast cancer; (2) Newly diagnosed at our institution between January 1, 2020, and January 31, 2022; and (3) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (4) Complete clinicopathological data (including estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67, grade, and stage); (5) Female. Exclusion Criteria: (1) Incomplete data (missing key biomarkers, treatment records, or follow-up data). (2) Prior history of breast cancer. (3) Prior history of active malignancy, except Non-melanoma skin cancer and malignancies cured\u0026thinsp;\u0026ge;\u0026thinsp;5 years prior to breast cancer diagnosis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe data collected included demographic information (e.g., age at BCA diagnosis, sex, menopausal status, and personal and family medical history). Clinical staging information (AJCC and TNM), histology type, Scarff-Bloom Richardson tumor grade, and immunohistochemically determined ER, PR, and HER2 receptor status data were collected from the tumor samples. First immunohistochemistry results were recorded if patients had received neoadjuvant therapy. In addition, clinical follow-up and treatment methods (surgical procedures, radiation, endocrine therapy, and adjuvant chemotherapy) were obtained from medical records.\u003c/p\u003e \u003cp\u003eMolecular Subtyping Definitions\u003c/p\u003e \u003cp\u003eWe defined tumors as ER or PR positive when their expression was \u0026ge;\u0026thinsp;1%. Tumors were classified as HER-2 positive if the immunohistochemistry (IHC) survey showed a score of 3\u0026thinsp;+\u0026thinsp;or if fluorescence in situ hybridization (FISH) indicated a HER2/CEP17 ratio of \u0026ge;\u0026thinsp;2.\u003c/p\u003e \u003cp\u003ePatients were assigned to two groups based on whether their cases were discussed at a multidisciplinary meeting.\u003c/p\u003e \u003cp\u003eIHC-genomic discordance: In HR+/HER2\u0026thinsp;\u0026minus;\u0026thinsp;breast cancer, genomic recurrence risk was stratified using the TAILORx trial criteria. High genomic risk: 21-gene Recurrence Score (RS)\u0026thinsp;\u0026ge;\u0026thinsp;26 (indicating chemotherapy benefit), intermediate genomic risk: RS 11\u0026ndash;25, low genomic risk: RS\u0026thinsp;\u0026le;\u0026thinsp;10[12, 13]. Molecular subtyping by immunohistochemistry followed the St. Gallen International Expert Consensus guidelines.\u003c/p\u003e \u003cp\u003eSubgroups:\u003c/p\u003e \u003cp\u003eEarly-stage HR+/HER2- breast cancer patients: (1) patients diagnosed with invasive breast cancer, (2) patients with stage I-II breast cancer, and (3) patients who were HR positive and HER-2 negative according to IHC.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMDT\u003c/h3\u003e\n\u003cp\u003eMDT met every 7 days, and the participating physicians had the following disciplines: surgical, radiation, medical, interventional radiology, pathology, and ultrasound specialist. While all patients were eligible for MDT review, referrals were typically initiated by treating physicians based on clinical complexity, discordant biomarker results, or ambiguous risk stratification.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were compared using Fisher's exact test or Pearson's χ\u0026sup2; test, as appropriate (Fisher's test for expected cell counts\u0026thinsp;\u0026lt;\u0026thinsp;5). Continuous variables were analyzed with Student's t-test for normally distributed data or Mann-Whitney U test for non-parametric data. Multivariable Cox proportional hazards models were constructed to adjust for clinically relevant covariates. Multivariable Cox regression analysis was performed for DSS of invasive breast cancer. Hazard ratios (HRs) with 95% confidence intervals (CIs) and \u003cem\u003eP\u003c/em\u003e-values were reported. Propensity score matching (1:1) was applied to balance baseline characteristics, Standardized Mean Difference (SMD)\u0026thinsp;\u0026lt;\u0026thinsp;0.1.\u003c/p\u003e \u003cp\u003eTo account for variable follow-up times and avoid immortal time bias, our survival analyses rigorously adhered to the principles of right-censoring. Time-zero was defined as the date of initial pathological diagnosis. Patients were right-censored at the date of their last documented clinical follow-up if they were without evidence of disease-related event (for Disease Specific Survival, DSS) by the study's data closure date (November 30, 2024). This approach ensures that all patients contribute person-time to the analysis only for the duration they were under active observation. To ensure that differences in outcomes were not artifactual due to unequal follow-up, we formally compared the distribution of follow-up times between the MDT and non-MDT cohorts. As follow-up time was non-normally distributed, the Mann-Whitney U tes\u003cb\u003et\u003c/b\u003e (for two-group comparison) was employed.\u003c/p\u003e \u003cp\u003eAll the statistical analyses were performed with SPSS software (version 22.0), with visualization in GraphPad Prism (version 8.0). Statistical significance was set at a two-sided \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of 472 breast cancer patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal No%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian(range)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53(25,86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMenopause\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremenopause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200(42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostmenopause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e272(57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory Of Malignancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e429(90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e271(57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137(29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUS-guided vacuum-assisted biopsy before surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96(20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e376(79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast-Conserving\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161(34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311(65.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSLNB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e329(69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALND\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183(38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e289(61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceive Neoadjuvant therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e446(94.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunohistochemical type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285(60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR+/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMDT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175(37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21 Gene test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccordant with IHC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisaccordant with IHC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eET\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e295(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225(47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247(52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eNOTE: SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; MDT, multidisciplinary team; ET, endocrine therapy.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 472 patients were included in this study. Median follow-up was 38.6 months (IQR 10.7 to 56.8 months), with no difference between cohorts (MDT group: 38.2 months vs. observed group: 39.2 months, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.405). The median age of the patients was 53 years (range 25 to 86 years). Among the female patients, 200 (42.4%) were premenopausal, and 272 (57.6%) were postmenopausal. 9.1% of patients had a history of malignancy. A total of 271 (57.4%) and 137 (29.1%) patients were in stages I and II, respectively. A total of 96 (20.3%) patients underwent US-guided vacuum-assisted biopsy before curative surgical resection under local anesthesia. Only 26 (5.5%) patients received neoadjuvant therapy. A total of 161 (34.1%) patients received breast-conserving surgery. The rates of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) were 69.7% and 38.8%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among 23 patients who underwent 21-gene recurrence score testing, 9 (39.1%) exhibited IHC-genomic risk discordance based on predefined St. Gallen vs. TAILORx criteria. The most common IHC subtype is HR positive /HER-2 negative (60.4%). The HR negative/HER-2 positive and HR negative/HER-2 negative subtypes accounted for only 14.2% and 15.2%, respectively. A total of 323 (68.4%) patients received endocrine therapy (ET), 297 (62.9%) patients received chemotherapy, and 227 (48.1%) patients received radiotherapy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eNOTE: LVI Lymphovascular Invasion; DSS, Disease Specific Survival\u003c/h3\u003e\n\u003cp\u003eAccording to the multivariate Cox regression analysis of DSS for invasive breast cancer patients, significantly better DSS was associated with MDT (YES vs NO; HR\u0026thinsp;=\u0026thinsp;0.292, CI: 0.096\u0026ndash;0.887, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030), HR positive Status (Positive vs Negative) ; HR\u0026thinsp;=\u0026thinsp;0.066, CI: 0.015\u0026ndash;0.212, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a lower Stage (ⅠvsⅡ, HR\u0026thinsp;=\u0026thinsp;0.005, CI:0.000-0.053, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Ⅰvs Ⅲ, HR\u0026thinsp;=\u0026thinsp;0.003, CI: 0.000-0.043, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001,Ⅰvs Ⅳ, HR\u0026thinsp;=\u0026thinsp;0.053, CI: 0.004\u0026ndash;0.703, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0.026, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Comparative analysis of MDT (n\u0026thinsp;=\u0026thinsp;297) vs Observed group (n\u0026thinsp;=\u0026thinsp;175) cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMDT group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObserved group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian (range)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.0(25,85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.5(32,86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237(79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154(88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMenopause\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114(65.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of malignancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e271(91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158(90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAJCC-Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169(56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79(45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eⅣ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast-conserving\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190(64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSLNB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204(68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e93(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALND\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118(39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179(60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeoadjuvant therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e284(95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162(92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEndocrine therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205(69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118(67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e92(31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199(67.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e98(33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79(45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e139(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDCIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245(82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eILC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunohistochemical type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175(58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHR+/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1year Regular follow-up checks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282(94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165(94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2year Regular follow-up checks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3year Regular follow-up checks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144(82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients were grouped based on whether they were discussed at the MDT; 297 patients were in the MDT group, and 175 patients were in the observed group. Statistical comparisons between groups revealed significant differences in age, menopause status, AJCC stage, chemotherapy, radiotherapy, pathology, and 2 and 3 years of regular follow-up. The MDT group had a median age (range) of 52.0 years (25, 85). In the observed group, the median age (range) of the patients was 55.5 years (32, 86). Compared with those in the observed group, patients in the MDT group were younger, with more patients aged 45 years and younger (20.2% vs 12.0%, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.022) and a greater number of premenopausal patients (46.8% vs 34.9%, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.011), Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no statistically significant differences detected in surgical categories (breast-conserving surgery, 36.0% vs 30.9%, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.252; SLNB, 68.7% vs 71.4%, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.531; and axillary dissection, 39.7% vs 37.1%, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.577). The results of the pathological type analysis revealed a greater proportion of carcinoma in situ (29,16.6%). Therefore significant differences were observed in the AJCC stage (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). In addition, a comparison of immunohistochemical type revealed no significant difference between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.764, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), either receiving ET (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.719, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Patients in the MDT group were more likely to receive chemotherapy and radiation (67.0% vs 54.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017; 53.2% vs 38.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Although first-year follow-up rates were slightly higher in the MDT group, the difference was not statistically significant (94.9% vs 94.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.756). The MDT group showed superior 3-year follow-up adherence (90.2% vs 82.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), with absolute increases of 6.0% (Year 2) and 7.9% (Year 3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment patterns in propensity-matched HR+/HER2- cohort (n\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMDT group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObserve group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21gene\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEC4-T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEC4/TC4-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOFS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOFS\u0026thinsp;+\u0026thinsp;SERM/AI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSERM/AI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient refusal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eclinically indicated omission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensified radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNOTE: EC4-T4: Epirubicin plus Cyclophosphamide for 4 cycles followed by Taxotere for 4 cycles; EC4: Epirubicin plus Cyclophosphamide for 4 cycles; TC 4\u0026ndash;6: Taxotere plus Cyclophosphamide for 4 to 6 cycles. OFS: Ovarian function suppression; SERM: Selective Estrogen Receptor Modulator, AI: Aromatase Inhibitors, RNI: regional nodal irradiation.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 215 cases with HR+/HER2-negative stage I\u0026ndash;II breast cancer were identified from the initial cohort of 472 patients. Propensity score matching (1:1) was applied to balance baseline characteristics, including menopausal status, breast-conserving, and lymph node involvement. This generated 140 well-matched cases, with all SMD below 0.1, indicating adequate covariate balance. A significantly greater proportion of MDT-managed patients underwent 21-gene assay testing (20.0%) than controls (7.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). A total of 37.1% of patients in the MDT group received TC or EC, 57.1% did not receive any chemotherapy, 18.6% of those in the observed group received TC or EC, and 60.0% did not receive any chemotherapy. Notably, the EC-T regimen was administered significantly more frequently in the observed group (21.4% [15/70]) than in the MDT group (5.7% [4/70], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.005, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, a greater percentage of patients in the MDT group received ovarian function suppression (OFS) combined with TAM or EXE (20.0% vs 7.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e Radiotherapy omission rates were identical across groups (52.9% in both arms), primarily driven by guideline-concordant indications for radiotherapy avoidance. Patient refusal rates were numerically lower in the MDT cohort (11.4% vs 14.3%). MDT cases showed marginally higher utilization of dose-escalated radiotherapy and comprehensive regional nodal irradiation (RNI).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreast cancer is a biologically heterogeneous disease comprising distinct molecular subtypes that necessitate divergent therapeutic pathways. This complexity underscores the critical role of MDT approaches in integrating surgical, systemic, and radiation therapies to optimize oncological outcomes while preserving quality of life. MDT approaches enhance staging precision and optimize treatment selection for upper gastrointestinal malignancies, as evidenced in gastric and esophageal cancers[14]. Robust evidence confirms MDT-associated survival benefits across malignancies[15, 16]. In a propensity-matched analysis by Tsai et al., MDT-managed patients demonstrated significantly reduced recurrence risk (HR\u0026thinsp;=\u0026thinsp;0.84, 95% CI: 0.70\u0026ndash;0.99) [17]. In our study, receiving MDT associated with better DSS (HR\u0026thinsp;=\u0026thinsp;0.292, CI: 0.096\u0026ndash;0.887, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Similarly, Xu et al. reported superior overall survival in MDT-managed breast cancer patients with brain metastases compared to non-MDT controls (OS: 34.2 months vs 8.2 months). Despite these advances, the impact of MDT decision-making on therapeutic strategies for biologically discordant luminal tumors, where IHC classification conflicts with genomic risk profiling, remains poorly characterized, forming the rationale for our investigation.\u003c/p\u003e \u003cp\u003eOur study extends this paradigm by demonstrating MDT's critical role in resolving therapeutic uncertainty for biomarker-discordant cases. In this study, among the 23 patients who underwent 21-gene assay 39.1% (9/23) exhibited discordance between genomic risk stratification and conventional IHC classification, precisely the scenario where standard biomarkers fail to guide appropriate therapy. Our findings reveal significant divergence in treatment decision-making between the MDT and observe cohorts. The absolute difference in overall chemotherapy utilization (42.9% in MDT vs. 40.0% in controls, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.72) was indeed not statistically significant. However, there is a significant 15.7% absolute reduction in the use of aggressive, anthracycline-based regimens (EC-T: 5.7% in MDT vs. 21.4% in controls, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). The marked reduction in EC-T use underscores the role of MDT in de-escalating therapy for patients unlikely to benefit from more toxic regimens, thereby avoiding unnecessary side effects (e.g., cardiotoxicity, secondary malignancies) without compromising survival. The significant reduction in aggressive EC-T regimens, despite similar overall chemotherapy rates, suggests that MDT discussion shifted treatment patterns towards less toxic options for selected patients. This may reflect a more nuanced interpretation of individual patient risk, potentially aided by the higher utilization of the 21-gene assay (20.0% vs. 7.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), which provides a more precise recurrence risk estimate than IHC alone. In summary, while the overall propensity to give chemotherapy was similar between groups, the MDT's impact was to re-allocate patients to more appropriate, risk-stratified regimens. This represents a highly clinically meaningful improvement in the quality of decision-making, moving away from a one-size-fits-all approach towards precision medicine.\u003c/p\u003e \u003cp\u003e \u003cb\u003eB\u003c/b\u003easeline characteristics revealed expected selection biases: MDT cohort exhibited higher proportions of younger patients (median age 52.0 vs 55.5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022), and age\u0026thinsp;\u0026le;\u0026thinsp;45 years(20.2% vs 12.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011), consistent with clinical prioritization of high-risk demographics for multidisciplinary evaluation. Although AJCC stage distribution differed significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), this disparity was predominantly driven by a higher proportion of Stage 0 (DCIS) cases in the non-MDT group (12.6% vs 3.4%). Surgical management demonstrated homogeneity between cohorts (breast-conserving surgery: 36.0% vs 30.9%; SLNB: 68.7% vs 71.4%; ALND: 39.7% vs 37.1%; all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.1), attributable to surgeries occurring prior to MDT referral. This highlights a critical limitation in assessing MDT's surgical impact within current care pathways. The null surgical findings contrast with MDT-associated increases in breast conservation reported by Kesson et al[18], likely reflecting temporal discordance between surgical decisions and MDT review in our cohort. This highlights the need for prospective evaluation of preoperative MDT models for biomarker-discordant cases, particularly where genomic risk profiles could influence surgical planning, avoidance of axillary dissection in genomic-low cN1 disease. While MDT participation was influenced by age and stage, its survival benefit persisted after risk adjustment via PSM and multivariable regression (in supplementary TableS2 and Table S3). This suggests outcome improvements are primarily attributable to MDT driven decision-making, not to selection bias.\u003c/p\u003e \u003cp\u003eAlthough statistical significance was not achieved, the directional trends toward reduced treatment refusal and increased utilization of precision radiotherapy techniques in the MDT cohort merit further investigation in larger cohorts.\u003c/p\u003e \u003cp\u003eWhile our initial data showed higher RT rate in MDT managed patients (53.9% vs\u003c/p\u003e \u003cp\u003e38.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), our risk-adjusted analysis revealed critical nuances: after controlling for nodal status and surgical approach (breast conservation), the initial 15.6% absolute reduction in RT omission lost statistical significance. This paradox suggests that the observed RT utilization gap may stem from three latent factors: MDT groups included more high-risk cases requiring RT, as MDT protocols often prioritize complex presentations. When risk-stratified, comparable-stage patients received RT at similar rates. After adjusting for clinicopathological factors, the initial difference in radiotherapy rates was attenuated, indicating that the decision for radiotherapy was primarily guided by established clinical guidelines rather than being significantly altered by MDT review alone \u003cb\u003eGl\u003c/b\u003eobal data contextualize these findings: RT omission rates range from 7\u0026ndash;25% across healthcare systems[19\u0026ndash;21], with MDT-discordant implementation occurring in 7\u0026ndash;16% of cases[22, 23]. Crucially, Bortot et al.[23]demonstrated that 72% of deviations stemmed from patient preferences, highlighting MDT's unrealized potential for shared decision-making in adjuvant therapy. While our MDT cohort showed no statistical RT utilization advantage, its 20% relative reduction in treatment refusal (11.4% vs 14.3%).\u003c/p\u003e \u003cp\u003eIn early-stage HR+/HER2- breast cancer, optimizing disease-free survival (DFS) while minimizing overtreatment remains paramount. The 21-gene recurrence score (RS) assay provides prognostic refinement beyond clinicopathological factors, guiding chemotherapy decisions[24, 25]. Our analysis demonstrates that MDT integration significantly increased chemotherapy utilization (2.9% absolute difference; 42.9% vs 40.0%) while reducing aggressive EC-T regimens (5.7% vs 21.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). This shift toward precision therapy reflects MDT's capacity to identify recurrence risk through multidimensional assessment, particularly valuable when genomic testing is precluded by socioeconomic barriers. Treatment selection patterns further validated guideline-concordant de-escalation.\u003c/p\u003e \u003cp\u003eOur findings demonstrate a pivotal role of MDT in optimizing endocrine therapy intensification for high-risk premenopausal patients. The MDT cohort exhibited significantly higher utilization of ovarian function suppression (OFS) combined with tamoxifen or aromatase inhibitors (20.0% vs 7.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), translating to a 2.8-fold increase in guideline-concordant care. For high-risk premenopausal patients, antiestrogen plus ovarian function suppression (OFS), such as the administration of gonadotropin-releasing hormone analogs (aLHRH) plus exemestane or tamoxifen can increase DFS [26]. However, the absence of DFS benefit in our median 3.2-year follow-up mirrors SOFT's early data, cautioning against OFS overuse in intermediate-risk cases. MDT's value lies in distinguishing true SOFT high-risk (OFS essential) from TEXT intermediate-risk (consider chemo instead).\u003c/p\u003e \u003cp\u003eBeyond survival and treatment optimization, a key practical benefit of the MDT-coordinated pathway was a significant improvement in long-term surveillance adherence. NCCN proposes clinical follow-up with medical history and physical examination every three months during the first 2\u0026ndash;3 years[27]. A key practical benefit demonstrated by the MDT-coordinated pathway was a significant improvement in 3-year follow-up adherence (90.2% vs 82.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). The enhancement likely stems from MDT's structured closing-the-loop systems: 1) Centralized tracking, 2) Patient navigators, 3) Multidisciplinary survivorship plans. By ensuring more patients complete their recommended surveillance schedule during the critical peak recurrence window (Years 2\u0026ndash;3 post-diagnosis), the MDT model creates vital opportunities for earlier detection of recurrence and more timely intervention. This directly addresses identified attrition risks, older age at diagnosis, tumor stage, and no prior receipt of radiation, chemotherapy, or endocrine therapy were risk factors for loss to follow-up[28, 29].\u003c/p\u003e \u003cp\u003eTo our knowledge, this is one of the few studies to quantitatively assess the impact of MDT on systematic impact on chemotherapy de-escalation in luminal breast cancer. The observed 3.4-fold increase in 21-gene testing utilization and 14.4% absolute reduction in anthracycline-based chemotherapy. These findings substantiate MDT's role in resolving therapeutic ambiguity when IHC and genomic risk diverge.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eWhile this study provides insights into MDT impacts, several limitations warrant discussion. First, the single-center, retrospective design may limit the generalizability of our findings to other institutions with different patient demographics or healthcare practices. Second, the retrospective nature introduces potential biases in data collection and analysis, as it relies on existing medical records, which may be incomplete or inconsistent. And evolving treatment guidelines during the study period could confound outcome comparisons, as later cases may have benefited from updated therapies. Thirdly, the relatively small sample size may reduce the statistical power and limit the ability to detect significant differences or rare outcomes. Residual confounding may persist despite propensity matching, as variables like comorbidities or genetic risk factors were unavailable in registry data. Fourth, the number of patients who underwent the 21-gene recurrence score assay in our cohort was relatively small (n\u0026thinsp;=\u0026thinsp;23), which limits the generalizability of our findings regarding IHC-genomic discordance and precluded a more robust statistical analysis of this specific subgroup. This was primarily due to the high cost of the test and its selective reimbursement policy in our healthcare system during the study period, which restricted its application to only the most complex or ambiguous cases. However, it is noteworthy that even within this small, select group, the rate of discordance was substantial (39.1%), highlighting the clinical relevance of this scenario and the potential value of MDT in addressing it. Future prospective studies with pre-specified universal genomic testing are warranted to definitively assess the impact of MDT on biomarker-discordant populations. These limitations highlight the need for future prospective, multicenter studies to validate and expand upon our findings. Multicenter, prospective studies are necessary to validate our conclusions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Institutional Ethics Committee of The First Affiliated Hospital of Ningbo University (Approval number: NO.039RS-01), with waiver of informed consent. All procedures performed in this study were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors approved the publication of this version.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003ePlease send requests to access this dataset to the author, Dr. Yao. ([email protected]).\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eLingli Yao: Conceptualized the study, performed data analysis, and drafted the manuscript. Jiayi Yu : Conducted primary data collection. Qingqing He: Designed statistical methodologies and performed data validation. Dan Ye: Prepared Tables 1 and 2. Dongbo Shi and Yu Guo: Contributed to the initial study design and intellectual content. Jiali Yang for proofreading the manuscript\u003c/p\u003e\n\u003cp\u003eAcknowledgement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray, F., et al., \u003cem\u003eGlobal cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.\u003c/em\u003e CA Cancer J Clin, 2024. \u003cstrong\u003e74\u003c/strong\u003e(3): p. 229-263.\u003c/li\u003e\n\u003cli\u003eWaks, A.G. and E.P. Winer, \u003cem\u003eBreast Cancer Treatment: A Review.\u003c/em\u003e Jama, 2019. \u003cstrong\u003e321\u003c/strong\u003e(3): p. 288-300.\u003c/li\u003e\n\u003cli\u003eHarbeck, N. and M. 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interventional cohort study of 13 722 women.\u003c/em\u003e Bmj, 2012. \u003cstrong\u003e344\u003c/strong\u003e: p. e2718.\u003c/li\u003e\n\u003cli\u003eStirling, R.G., et al., \u003cem\u003eMultidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis.\u003c/em\u003e Eur Respir Rev, 2024. \u003cstrong\u003e33\u003c/strong\u003e(172).\u003c/li\u003e\n\u003cli\u003eTsai, C.H., et al., \u003cem\u003eEffect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study.\u003c/em\u003e Breast, 2020. \u003cstrong\u003e53\u003c/strong\u003e: p. 68-76.\u003c/li\u003e\n\u003cli\u003eFancellu, A., et al., \u003cem\u003eThe importance of the multidisciplinary team in the decision-making process of patients undergoing neoadjuvant chemotherapy for breast cancer.\u003c/em\u003e Updates Surg, 2024. \u003cstrong\u003e76\u003c/strong\u003e(5): p. 1919-1926.\u003c/li\u003e\n\u003cli\u003eLiu, J., et al., 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Med Inform Decis Mak, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 111.\u003c/li\u003e\n\u003cli\u003eBortot, L., et al., \u003cem\u003eMultidisciplinary Team Meeting Proposal and Final Therapeutic Choice in Early Breast Cancer: Is There an Agreement?\u003c/em\u003e Front Oncol, 2022. \u003cstrong\u003e12\u003c/strong\u003e: p. 885992.\u003c/li\u003e\n\u003cli\u003eCopson, E.R., et al., \u003cem\u003eExpert UK consensus on the definition of high risk of recurrence in HER2-negative early breast cancer: A modified Delphi panel.\u003c/em\u003e Breast, 2023. \u003cstrong\u003e72\u003c/strong\u003e: p. 103582.\u003c/li\u003e\n\u003cli\u003eZhang, Y., et al., \u003cem\u003eKi-67 index, progesterone receptor expression, histologic grade and tumor size in predicting breast cancer recurrence risk: A consecutive cohort study.\u003c/em\u003e Cancer Commun (Lond), 2020. \u003cstrong\u003e40\u003c/strong\u003e(4): p. 181-193.\u003c/li\u003e\n\u003cli\u003ePagani, O., et al., \u003cem\u003eAbsolute Improvements in Freedom From Distant Recurrence to Tailor Adjuvant Endocrine Therapies for Premenopausal Women: Results From TEXT and SOFT.\u003c/em\u003e J Clin Oncol, 2020. \u003cstrong\u003e38\u003c/strong\u003e(12): p. 1293-1303.\u003c/li\u003e\n\u003cli\u003eGradishar, W.J., et al., \u003cem\u003eBreast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology.\u003c/em\u003e J Natl Compr Canc Netw, 2024. \u003cstrong\u003e22\u003c/strong\u003e(5): p. 331-357.\u003c/li\u003e\n\u003cli\u003eKukar, M., et al., \u003cem\u003eFostering coordinated survivorship care in breast cancer: who is lost to follow-up?\u003c/em\u003e J Cancer Surviv, 2014. \u003cstrong\u003e8\u003c/strong\u003e(2): p. 199-204.\u003c/li\u003e\n\u003cli\u003eRuddy, K.J., et al., \u003cem\u003eFollow-up Care for Breast Cancer Survivors.\u003c/em\u003e J Natl Cancer Inst, 2020. \u003cstrong\u003e112\u003c/strong\u003e(1): p. 111-113.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"multidisciplinary team quality, breast cancer, survival","lastPublishedDoi":"10.21203/rs.3.rs-8499154/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8499154/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMultidisciplinary teams (MDTs) have been shown to improve breast cancer outcomes. This study aimed to examine the effect of MDT on therapeutic decision-making for breast cancer (BCA) patients, particularly in the subtype of early-stage HR+/HER2-BCA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analyzed 472 breast cancer patients who were first diagnosed at our institution between 1 January, 2020, and 31 January, 2022. The clinicopathological features were obtained from medical records. Patients were assigned to two groups on the basis of whether their cases were discussed at the MDT. Propensity score matching (1:1) generated 140 well-balanced cases in the early-stage HR+/HER2- subgroup. Cox regression and chi-square tests were used to evaluate survival and treatment differences.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results of Cox regression revealed that better DSS was associated with MDT (YES vs NO; HR\u0026thinsp;=\u0026thinsp;0.292, CI: 0.096\u0026ndash;0.887, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030), HR Status (Positive vs Negative) ; HR\u0026thinsp;=\u0026thinsp;0.066, CI: 0.015\u0026ndash;0.212, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a lower Stage (I vs II, HR\u0026thinsp;=\u0026thinsp;0.005, CI:0.000-0.053, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; I vs III, HR\u0026thinsp;=\u0026thinsp;0.003, CI: 0.000-0.043, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001,I vs IV, HR\u0026thinsp;=\u0026thinsp;0.053, CI: 0.004\u0026ndash;0.703, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). The rates of 2- and 3-year regular follow-up in the MDT group were greater than those in the observed group (92.9% vs 86.9%, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.028; 90.2% vs 82.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). In the subgroup, MDT integration significantly increased chemotherapy utilization (42.9% vs 40.0%) while reducing aggressive EC-T regimens (5.7% vs 21.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). MDT was associated with increased use of 21-gene test and ovarian function suppression (OFS) in this subgroup (20.0% vs 7.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eMDT discussion was associated with more precise treatment strategies in HR+/HER2- breast cancer, as evidenced by increased use of genomic testing, chemotherapy de-escalation, and improved long-term follow-up adherence.\u003c/p\u003e","manuscriptTitle":"Impact of Multidisciplinary Team Discussion on Treatment Decision-Making and Survival in Early-Stage HR+/HER2-Breast Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 09:13:41","doi":"10.21203/rs.3.rs-8499154/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-04T06:59:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T02:52:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49872025640689578196424033472447955456","date":"2026-02-25T04:12:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T06:23:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210665605950899707447034775397052506184","date":"2026-01-20T05:55:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T10:58:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T14:16:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-04T22:09:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Surgical Oncology","date":"2026-01-02T07:55:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea1ab45e-6c63-4653-bb58-b3ee71513801","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T07:11:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 09:13:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8499154","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8499154","identity":"rs-8499154","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}