Analysis of Chemotherapy Regimens on Survival Rate of Breast Cancer Patients

Analysis of Chemotherapy Regimens on Survival Rate of Breast Cancer Patients | 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 Article Analysis of Chemotherapy Regimens on Survival Rate of Breast Cancer Patients Yulistiani Yulistiani, Febriansyah Nur Utomo, Pradana Zaky Romadhon, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3841276/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Breast cancer in Indonesia is among the first with the highest number of new cancer cases with the second mortality in cancer after lung cancer in 2020. Anthracycline-taxane based regimens and taxane-based regimens are often breast cancer chemotherapy modalities that can support increased patient survival. Side effects occur more frequently in combination regimens. The selection of the right regimen is expected to support the improvement of patient survival. This study aims to analyze the survival rate of chemotherapy regimen groups and hazard ratio factors that are thought to affect survival in breast cancer patients. This study used an observational and retrospective cohort method. The statistical analyzes used in this study include Kaplan-Meier analysis to measure survival rates, Log-rank test to observe the differences between regimen groups and Cox proportional hazards regression to analyze factors that influence survival. Patients who were included in the inclusion and exclusion criteria were 71 patients, consisting of 47 patients who received anthracycline-taxane based combination and 24 patients who received taxane-based chemotherapy. The percentage of one-year and two-year survival in the anthracycline-taxane based combination was 93.6% and taxane-based 83.3% (p>0.05). Multivariate analysis showed that stage increased risk 9 times based on hazard ratio values obtained from cox regression tests (HR 9.60; 95% CI 1.60-57.54; p<0.05). Another significant factor in the multivariate analysis was that delaying chemotherapy increased the risk of survival 5 times (HR 5,58; CI 95% 1.12-27.85 ; p<0.05). Based on research, it can be concluded that anthracycline-taxane based and taxane based combination regimens can be used as a treatment modality for breast cancer patients in both early and advanced stages. Biological sciences/Cancer Biological sciences/Cancer/Breast cancer Biological sciences/Cancer/Cancer therapy breast cancer chemotheraphy anthracycline taxane survival rate Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Breast cancer is a group of diseases that cause abnormal changes and divisions in cells within the breast tissue usually resulting in lumps or masses (ACS, 2019). Breast cancer is among the most commonly diagnosed cancers in women worldwide with more than 2 million new cases (11.7%) in 2020. Breast cancer mortality in the world in 2020 reached 684,996 (6.9%) (WHO, 2020). According to data from Global Cancer Statistics (2020), in Indonesia breast cancer ranks first with the highest number of new cases of cancer and is the second contributor to cancer mortality after lung cancer. The number of new cases amounted to 65,858 or 16.6% of the 396,914 new cases of cancer in Indonesia with a mortality rate of 22,430 cases. The incidence rate in Indonesia is estimated at 44/100,000 women (WHO, 2020). Breast cancer patients in Indonesia are recorded as having the highest number of stage IIIB included in the advanced stage (Widiana & Irawan, 2020). The principle of treatment of advanced breast cancer is palliative therapy with systemic therapy which is the primary therapy (chemotherapy and hormonal therapy) if necessary can use radiation therapy and surgery (Kemenkes, 2018). Cancer chemotherapy can be a combination of several drugs (chemotherapy regimens) with the aim of killing cancer cells (Arianto, 2017). Research by Rossi et al. , (2015) demonstrated the benefits of chemotherapy administration. The study involved invasive breast cancer patients stating overall survival (OS) in the no-chemotherapy group compared to the chemotherapy group of 87.6% versus 92.1% (5 years) and 75.0% versus 81.9% (10 years), respectively. The extrapolated data showed that chemotherapy lowered the relative risk of death by 25% (HR = 0.75) and the relative risk of metastasis by 18% (HR = 0.82). These results are supported by a study by Bonadonna & Valagussa, (1981) which was the first to show that the full dose group of chemotherapy (> 85%) cyclophosphamide, methotrexate and 5-fluorouracil (CMF) provided disease free survival (DFS) of 77% compared to the group treated with only radical mastectomy i.e. 45%. The following study states the superiority of anthracyclines and taxane-containing regimens (adriamycin, cyclophosphamide followed by taxanes) achieving the greatest risk reduction in breast cancer (Waks & Winer, 2019; Krajc et al. , 2020). A meta-analysis study from the Early Breast Trialist's Collaborative Group (EBTCG) is comparing between CMF and anthracycline-based regimens. Better results were observed on anthracycline-based regimens compared to CMF which could reduce recurrence rates by 11% and reduce breast cancer mortality rates by 16%. The combination of docetaxel or paclitaxel with anthracycline leads to improved outcomes in advanced stages ( Estevez et al. , 2007). Previous studies by Romadhon et al. , (2021) have examined the relationship between plasma levels of miRNA-21 and overall survival rate as a prognostic factor in breast cancer at Airlangga University Hospital. However, based on a search of the current library, research on the analysis of chemotherapy regimens for survival in breast cancer patients housed in Airlangga University Hospital has not been conducted. Survival analysis includes metrics for assessing disease mortality and morbidity, survival rates related to risk factors and success of cancer treatment therapies (Dwidayati, 2012; Romadhon et al. , 2021). The difference in therapeutic outcomes shows the importance of choosing the right regimen for breast cancer patients. Choosing the right regimen is expected to support improved patient survival. The study provides an overview of survival information through the Kaplan-Meier curve as well as the factors that are thought to affect survival obtained at hazard ratio values. Based on this description, the aim of this study was to analyze chemotherapy regimens in breast cancer patients at Airlangga University Hospital who used anthracycline-taxane-based combination regimens and taxane-based regimens for survival and to identify factors that may influence it including age, stage, comorbidity/complications, and chemotherapy delay. RESEARCH METHOD The method of this study was an analytic observational study using a cohort retrospective method with quantitative analysis. The research was conducted at the Integrated Oncology Installation of Airlangga University Hospital. The study population was all patients with advanced breast cancer who were first diagnosed on January 1st, 2018 — August 30th, 2022 and received chemotherapy treatment at Airlangga University Hospital. The samples in this study were all breast cancer patients who had undergone chemotherapy since the first chemotherapy administration who met the inclusion criteria using the time-limited sampling method. The inclusion criteria of this study include 1) breast cancer patients > 18 years of age who were first diagnosed with or without comorbidities, receiving anthracycline and/or taxane based chemotherapy treatment at Airlangga University Hospital, 2) patients with complete medical records including identity, diagnosis, cytostatic drug therapy, clinical data, laboratory data, date of visit. The exclusion criterias of this study were 1) the patient was referred to another hospital, 2) the patient was male. All patients’ data for this study were collected from patients’ medical records and remain anonymized before and after data collection. The study was approved by the Research Ethics Committee of Rumah Sakit Universitas Airlangga and was declared to have passed the ethical review with a Certificate of the Ethics Review Approval Number 066/KEP/2023. Due to the retrospective nature of the study, the need of informed consent was waived by Research Ethics Committee of Rumah Sakit Universitas Airlangga. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. Data Analysis The characteristics of the patient distribution are presented in tables using crosstab and chi-square assays between the characteristics and the patient's chemotherapy regimen. Kaplan-Meier analysis to look at survival rates which are the percentage of people in the study who lived after diagnosis or start of therapy. Along the horizontal axis (X) there are units of time and along the vertical axis (Y), it indicates the probability of survival. Interpretation of the Kaplan-Meier curve by identifying the median of survival (the time when the probability of survival reaches 50%) and seeing that curve fluctuate over time. Log-rank test is used to determine if there are differences between survival curves between groups. Cox proportional hazard regression is used to determine the factors that influence response variables such as survival time. RESULT This study analyzed chemotherapy regimens against survival rates in breast cancer patients at Airlangga University Hospital from January 1st, 2018 to August 30th, 2022. The total number of patients who met the inclusion criteria was 76 patients. The excluded patients consisted of one male patient and four patients referred out. The total number of patients who met the inclusion and exclusion criteria in this study was 71 patients consisting of 47 patients receiving anthracycline-taxane-based combination and 24 patients receiving taxane-based chemotherapy. The characteristics of patients were grouped by age, first stage at diagnosis, comorbidities or complications, chemotherapy delay, ER receptor hormone status, PR, HER-2, chemotherapy regimen and patient survival status (Table 1 ). Most of the patients were adults when first diagnosed which was 78.9% while the other 21.1% of patients were elderly. In this study, the first stage at diagnosis was divided into groups of initial (I and II) and advanced stages (III and IV). Early stages account for 31.0% of all patients, while advanced stages account for 69.0%. Comorbidities in this study included hypertension (25.4%), diabetes (14.1%), pneumonia (2.8%), AKI (1.4%), congestive heart failure/CHF (1.4%), bronchitis (1.4%), COVID-19 (1.4%). In addition, breast cancer cells derived from the primary tumor can spread to other organs. Metastases in this study included liver (4.2%), lung (2.8%), bone (1.4%) and cerebrum (1.4%). The group of delays of less than 14 days in the study recorded 80.3%, while delays of more than 14 days were 19.7%. The study displayed characteristics of estrogen, progesterone, and HER-2 hormone receptors found in 62 patients based on immunohistochemical examination. Immunohistochemical examination of nine patients was not attached to the medical record. A total of 66.2% of patients showed hormone receptor (ER/PR) positive results while the other 21.1% had hormone receptor (ER/PR) negative. Examinations in 52.1% of patients showed overexpression of HER-2 and 35.2% with HER-2 negative. Table 1 Characteristics of breast cancer patients in the study Characteristic n % Age Adult ( 60 tahun) 15 21,1 Mean / SD 50,92 11,19 Stage Early Stage 22 31,0 I 4 5,6 II 18 25,4 Advanced Stage 49 69,0 III 38 53,5 IV 11 15,5 Comorbidies/Complications No 45 63,4 Yes 26 36,6 Hypertension 18 25,4 Diabetes 10 14,1 Pneumonia 2 2,8 AKI 1 1,4 CHF 1 1,4 Bronchitis 1 1,4 Covid-19 1 1,4 Liver Metastasis 3 4,2 Lung Metastasis 2 2,8 Cerebral Metastasis 1 1,4 Bone Metastasis 1 1,4 Chemotherapy Delay 14 days 14 19,7 ER/PR Negative 15 21,1 Positive 47 66,2 n/a 9 12,7 HER-2 Negative 25 35,2 Positive 37 52,1 n/a 9 12,7 Chemotherapy Regimen Anthracycline-taxane based combination 47 66,2 Taxan-based 24 33,8 Characteristics based on factors assumed to affect survival in both groups of regimens were tested using crosstab and chi-square assays. The crosstab and chi-square assays explain the distribution of patient distribution in studies using anthracycline-taxane-based and taxane-based combination regimens with certain characteristics. Catacteric by group regimen are listed in Table 2 . Chi-square test results of age group, stage, comorbidies/complications, delay of chemotherapy therapy showed no significant difference (p > 0.05). This shows that the sample data is evenly distributed among the groups. Table 2 Characteristics of factors based on chemotherapy regimens Characteristics Number of Chemotherapy Patients p -Value Anthracycline-taxane based combination Taxan based Age Adult ( 60 tahun) 9 6 Stage Early Stage 18 4 0,058 Advanced Stage 29 20 Comorbidies/Complications No 30 15 0,912 Yes 17 9 Chemotherapy Delay 14 days 8 6 An analysis of overall breast cancer patients’ survival is shown in Fig. 1 . The decreased Kaplan-Meier survival curve was due to the presence of events (mortality) during the study period. A positive sign describes the censored data over the observation period. The one-year and two-year survival curves of Kaplan-Meier breast cancer patients at Airlangga University Hospital are shown in Fig. 1 and Fig. 2 . The 1-year and 2-year survival percentages for anthracycline-taxane based combinations were 93.6% and taxane-based 83.3%. A log rank test showed that the two regimens did not differ significantly in terms of survival percentage (p > 0.05). The results of the analysis of the survival of breast cancer patients can be seen in Table 3 . Median survival in this study could not be assessed because in both groups of the regimens, 50% of patients had not died. Median survival is the time at which 50% of patients experience an event or mortality. Table 3 Survival rate results from Kaplan-Meier analysis Time/Length Survival Rate Log-rank Anthracycline-taxane based combination (n = 47) Taxan based (n = 24) p-Value OS 91,5% 83,3% 0,159 1 year 93,6% 83,3% 0,159 2 years 93,6% 83,3% 0,159 Cox proportional hazard regression analysis was performed to look at the factors that influence the survival parameters. The characteristics of ER/PR and HER-2 are included in this test. Bivariate analysis on predictor variables was using cox propotional hazard regression. Variables with p > 0.05 in bivariate analysis were then multivariate tested to determine their effects simultaneously. The results of the Cox regression analysis of these factors in breast cancer patients are shown in Table 4 and Table 5 . Chemotherapy stage and delay factors were significant factors affecting survival in multivariate analysis with significance of p > 0.05, respectively. Multivariate analysis showed that increased stage can increase the risk of mortality by 9 times based on the hazard ratio obtained (HR 9.602; 95% CI 1.602–57.536; p = 0.013). Other factors such as chemotherapy delay were among the factors that significantly influenced survival in this study (HR 5.576; 95% CI 1.16–27.850; p = 0.036). Based on the hazard ratio, a delay of chemotherapy > 14 days can increase the risk of mortality by up to 5 times. Table 4 Bivariate analysis of factors affecting survival of breast cancer patients Factor Frequency (%) HR (95% CI) p-value Age (n = 71) Adult ( 60 tahun) 15 (21,1) 0,538 (0,066 − 4,380) Stage (n = 71) I 4 (5,6) 16,729 (3,35–79,163) 0,001 II 18 (25,4) III 38 (53,5) IV 11 (15,5) Comorbidies/Complications (n = 71) No 45 (63,4) (ref) 0,034 Yes 26 (36,6) 5,640 (1,137 − 27,977) Chemotherapy Delay (n = 71) 14 days 14 (19,7) 8,140 (1,937 − 34,215) ER/PR (n = 62) Negative 15 (24,2) (ref) 0,318 Positive 47 (75,8) 0,399 (0,066 − 2,416) n/a 9 (12,7) HER-2 (n = 62) Negative 25 (40,3) (ref) 0,963 Positive 37 (59,7) 0,959 (0,160-5,757) n/a 9 (12,7) Table 5 Multivariable analysis of various factors related to survival of breast cancer patients Factor (n = 71) HR (95% CI) p-value Stage Comorbidies/Complications Chemotherapy Delay 9,602 (1,602 − 57,536) 2,260 (0,346 − 14,760) 5,576 (1,116 − 27,850) 0,013 0,394 0,036 Patient survival curves based on stage and delay of chemotherapy are shown in Fig. 3 and Fig. 4 . The observed probability of survival in the group of patients without delay of chemotherapy ( 14 days it was 64.3%. In this study, the probability of survival decreased with increasing stage. 2-year survival in stage I and stage II patients reached 100%, stage III 97.4% and stage IV 45.5%. Breast cancer patients undergoing chemotherapy often experience side effects after undergoing chemotherapy. This relates to the delay of chemotherapy which can affect the progression of a patient's cancer as well as the patient's acceptance of chemotherapy. Table 6 shows both regimens had similar side effects. The anthracycline-taxane-based combination regimen has a higher effect on nausea, vomiting, fever, dizziness, neutropenia and itching. More side effects occur with the taxane-based regimen in the form of diarrhea, tingling, decreased appetite and constipation. Table 6 Side effects of chemotherapy Side Effect Chemotherapy Anthracycline-taxane based combination (%) Taxan based (%) Nausea-vomiting 34,09 25,00 Diarrhea 29,55 41,67 Tingling 22,73 33,33 Fever 18,18 16,67 Dizziness 13,64 8,33 Neutropenia 11,36 8,33 Itching 11,36 4,17 Decreased Appetite 6,82 8,33 Constipation 2,27 8,33 DISCUSSION Survival analysis using Kaplan-Meier method aims to look at the survival of patients with survival percentage parameters. The results of the observations were plotted on the survival curve. The log-rank test was performed after the Kaplan-Meier survival curve results were established to compare whether there was a difference between the survival curves of the two groups of regimens. In addition, an analysis was carried out on factors that were assumed to affect survival. Side effects that occured during the course of a patient undergoing chemotherapy treatment were treated descriptively. The one-year and two-year survival percentages of anthracycline-taxane based combinations were 93.6% and taxane-based 83.3% (p > 0.05). Based on these data, taxane-anthracycline based combination regimens have a greater probability of survival than taxane-based, but not statistically significant. This is similar to a meta-analysis study by Zheng et al. , (2015), which compared the benefits of using a combination of anthracyclines along with taxanes versus a single agent-based chemotherapy regimen. The results showed that chemotherapy with a combination of anthracycline and taxane did not significantly improve OS of breast cancer patients when compared to OS achieved using taxane or anthracycline single agents (Zheng et al. , 2015). Several other studies compared combination versus taxane-based regimens in breast cancer patients. Caparica et al . (2018), in their systematic review and meta-analysis study comparing taxan-based regimens versus anthracycline- and taxane (AT) -based regimens in the treatment of breast cancer. Overall, no difference was observed between taxane-based and AT regimens against OS (HR 1.05; 95% CI 0.90–1.22). The incidence of nausea, vomiting, mucositis and thrombocytopenia significantly occurred in the combination regimen (Caparica et al ., 2018). The Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2023), noted that no significant reduction in the risk of recurrence was found for taxane and anthracycline administration when compared to docetaxel plus cyclophosphamide (RR 0.94; 0.83—1.06; p = 0.30). Therefore, the results of this study have shown the same results as previous studies. A meta-analysis of EBCTCG showed that anthracycline-containing and taxane-containing chemotherapy reduced the 10-year mortality rate of breast cancer by about a third. Four doses of anthracycline followed by four doses of docetaxel were as effective as the same drug combination, six times TAC but had different toxicity patterns. TAC requires granulocyte support due to high rates of neutropenic fever (Harbeck & Gnant, 2017). Taxans (paclitaxel and docetaxel) work by inhibiting microtubule dynamics that form microtubule polymerization as well as inhibiting depolymerization and resulting in cell cycle termination in G2 and M phases leading to cancer cell death (Basuki et al ., 2020; Hassanzadeh et al ., 2018). Paclitaxel and docetaxel are administered intravenously. Taxanes are metabolized by P450 in the liver with > 90% bound to plasma proteins. About 70% − 80% of the drug is excreted through the feces, while through the kidneys a relatively small less than 10% (Chu & Devita, 2019). The cytotoxic mechanism of anthracycline works by causing damage to the cell's DNA. Two major mechanisms are involved in anthracycline's toxic effects on cells. The anthracycline compound has a structure that allows it to fit into the DNA strand by interacting non-covalently resulting in anthracyclines being intercalated between DNA base pairs. This leads to disruption of the process of cell DNA synthesis. In addition anthracycline inhibits topoisomerase, which is an enzyme that opens the double strand of DNA in order for it to be replicated and synthesized. By disrupting the function of topoisomerase, anthracycline causes the cessation of cell growth and leads to apoptosis. Anthracyclines also form free radicals (ROS) that can cause single- and double-stranded DNA damage (Geisberg & Sawyer, 2010). The structure of anthracyclines is formed from anthraquinones bound to aminoglycosides (Corremans et al. , 2018). Anthracycline is administered intravenously because it has low intestinal solubility and permeability and a high intestinal first-pass effect (Lee et al. , 2023). About 75–80% of anthracyclines and their metabolites are bound to plasma proteins. Anthracycline is metabolized in the liver to active metabolites. About 40–50% excretion is through the fecal with less than 10% by the kidneys. Anthracycline has a higher risk of cardiotoxicity in patients > 70 years of age, in patients with a history of hypertension or heart disease. This is largely due to the mechanism of doxorubicin free radical formation (Chu & Devita, 2019). The main mechanism of doxorubicin cardiotoxicity is the increased oxidative stress shown from increased reactive oxygen levels of the species and lipid peroxidation (Chatterjee et al. , 2010). Further analysis was performed on the Cox proportional hazard regression test to determine the factors that affect the survival of breast cancer patients. Bivariate analysis shows that stage factors, presence of comorbidies/complications and chemotherapy delay of > 14 days may affect survival. Simultaneous multivariate analysis showed that the stage factor increased the risk nine times based on the hazard ratio obtained from the Cox regression test (HR 9.602; 95% CI 1.602–57.536; p = 0.013). 2-year survival in stage I and stage II patients reached 100%, stage III 97.4% and stage IV 45.5%. Another significant factor in the multivariate analysis was that chemotherapy delay increased 5-fold the risk of survival (HR 5.576; 95% CI 1.16–27.850; p = 0.036). The probability of survival in the group of patients without delay of chemotherapy ( 14 days it was 64.3%. This shows that increased stages can affect survival probability as in Alkabban & Ferguson (2022), stated that stage 0 and stage I had a 5-year survival rate of 100%. The 5-year survival rate for stage II and stage III breast cancer was approximately 93% and 72%, respectively. Systemic or stage IV spread of cancer caused the prognosis to deteriorate to 22% for 5-year survival. An estimated 20–30% of early-stage breast cancers metastasized to an advanced stage. A total of 6–10% of women with breast cancer in the United States was found to have stage IV disease at diagnosis (Wang et al. , 2019). Early detection efforts were very important because if breast cancer could be detected at an early stage and treated appropriately, the cure rate was quite high (80–90%). Early detection of breast cancer aims to detect and identify the presence of breast cancer early, so that patients receive therapy with a greater chance of cure (Kemenkes, 2013). Modification of the chemotherapy schedule increases the duration between cycles of chemotherapy, which consequently reduces the intensity of the treatment dose. Cytotoxic antitumor activity depends on the drug used and on the schedule of drug administration. Based on previous studies, cumulative delays of ≥ 14 days significantly increased mortality by 2.56 times (HR 2.56; p = 0.030) (Gunasekaran et al ., 2020). Another study reported a delay variable in the administration of anthracycline-based chemotherapy with the number of days of delay of more than 14 days or a delay in two cycles of chemotherapy can have a lower probability of survival without recurrence of the disease for ten years (Chirivella et al ., 2009). Hence, the duration of delay between cycles should be reduced whenever possible in order to achieve maximum chemotherapy benefits (Chirivella, 2009; Gunasekaran et al ., 2020). The results of multivariate cox regression analysis showed that comorbidities/complications were not a significant factor affecting survival. Comorbid is a condition accompanied by other systemic diseases or complications of breast cancer that spreads to other organs. These results are in line with studies by Netchuta et al showing that none of the comorbidities (comorbidities) studied (hypertension, chronic gastritis, diabetes mellitus, chronic bronchitis/asthma, CHD, stroke, chronic hepatitis and rheumatoid arthritis) significantly affect the risk of breast cancer recurrence (Netchuta et al ., 2013). Tests on age factors, and characteristics of ER/PR and HER-2 showed no significant differences in bivariate and multivariate assays. This indicates that these variables were not statistically significant. A study by Mirsyad et al. (2022), breast cancer patients at Makassar Ibnu Sina Hospital showed that there was no significant relationship between patient age and clinical stage level (p > 0.05). Patients' awareness of early examination/early detection also influences the patient's cancer stage (Mirsyad et al ., 2022). The characteristics of ER/PR and HER-2 were carried out through medical records. Estrogen receptors or progesterone receptors are proteins found on the surface of breast cancer cells. When estrogen or progesterone binds to its receptors, this can activate signaling pathways that promote breast cancer cell growth (Oza & Ma, 2017, Hart et al ., 2020; Li et al ., 2022). ER/PR positive cancer cells are sensitive to the presence of the hormones estrogen and progesterone. Cancer cells of this type are sensitive to hormonal therapy and have better cure rates compared to cancer cells that have neither estrogen receptors nor progesterone receptors (Kristian & Sandhika, 2021). Breast cancer cells with a positive HER-2 test result will be sensitive to anti-HER-2 monoclonal antibody therapy. In addition, it also has a high cell proliferation rate so that the cancer is more sensitive to chemotherapy (Kristian & Sandhika, 2021; Wawruszak et al ., 2021). A study by Kristian & Sandhika (2021), concluded that the increased degree of differentiation in cancer cells (grade) would be followed by a decrease in estrogen receptors and progesterone receptors in cancer cells, but there was no correlation between HER-2 examination results and the degree of histological differentiation of breast cancer cells. This shows that lower grade cancer cells have properties that are more similar to normal cells: they have estrogen and progesterone receptors and thus have lower cell growth rates compared to higher grade breast cancers that lose estrogen and progesterone receptors. HER-2 having no correlation with the degree of histological differentiation of cancer cells means that HER-2 can be possessed by breast cancer cells with varying degrees of malignancy (Kristian & Sandhika, 2021). In addition to factors that affect survival, the presence of incidences or events of adverse events is also an important factor affecting the quality of life of patients undergoing chemotherapy (Matwin et al. , 2021). In this study, due to the limited number of samples, there was no further statistical analysis could be performed. However, the data were descriptively processed to see the mean and day range of chemotherapy delays in breast cancer patients receiving anthracycline-taxane-based combination regimens and those receiving taxane-based regimens. The most common side effects judging by the percentage incidence of anthracycline-taxane-based combination regimens were nausea, vomiting (34%), diarrhea (29.55%), tingling (22.73%), fever (18.18%), and dizziness (13.64%). The use of the taxane-based regimen hasd almost the same side effects as the combination regimen, most of which included diarrhea (41.67%), tingling (33.33%), nausea vomiting (25%), fever (16.67%), neutropenia (8.33%). These results are in line with studies from Capatirca et al. , (2018) which concluded emesis/vomiting, mucositis and thrombocytopenia were significantly more frequent with anthracycline alongside taxanes. The effects of fatigue and nausea were the most frequently reported nonhematologic toxicities in the first cycle (Gadisa et al. , 2020). The same results were shown by the meta-analysis study of Zheng et al . (2015), which stated that taxane-based regimens had lower side effects in the form of neutropenia, infection/fever, nausea, and vomiting, but higher for hand-foot syndrome and diarrhea. In general, all chemotherapy drugs are at risk of causing nausea/vomiting, as they can damage the gastrointestinal tract and cause enterochromaffin cells present in the digestive tract especially in the small intestine to release nerve signals through the release of neurotransmitters, namely serotonin (5-HT). These neurotransmitters then activate the afferent fibers of the sarafvagus by binding to 5-HT3 receptors which then stimulate the dorsal complex of the vagus nerve, the chemoreceptor trigger zone, to trigger the motor response of nausea and vomiting (Kholida et al. , 2020). Diarrhea was the most common side effect found with the use of taxane-based regimens. The cytotoxic mechanism of paclitaxel stabilized the polymer structure of microtubules and inhibits depolymerization of microtubules back to tubulin. This process inhibited free tubulin and created an inefficient array of irregular microtubules for cell replication, thereby blocking mitosis. The toxic effect of paclitaxel was most pronounced on tissues with rapid cell turnover, including hematopoietic, lymphatic, gastrointestinal (GI), and reproductive tissues, as well as tissues affected by alopecia. Studies had identified neutropenia, neuropathy, mucositis, asymptomatic bradycardia, myalgia, arthralgia and diarrhea as major side effects of paclitaxel therapy (Ismail & Killeen, 2023). The side effects experienced by the patient became one of the causes of the delay until the discontinuation of the patient's chemotherapy which would have an impact on the progression of the disease. Additionally, observation of adverse events was important in improving the patient's quality of life making it necessary to monitor and alert pharmacists to these ESO events. The limitation in this study is to analyze the short-term viability (1 year and 2 years) only due to limitations in the study period. The next study is expected to analyze the medium term (3 years) and long-term (5 years) survival of breast cancer patients. In addition, other studies related to the cost aspects of treatment and observations on combinations of other types of therapy are needed so that comprehensive treatment results can be achieved. Addressing the side effects of therapy also improves quality of life, so further research is expected to focus on post-chemotherapy side effects of breast cancer. CONCLUSION AND SUGGESTION The survival rate of one year and two years in breast cancer patients who received treatment at Airlangga University Hospital with a 93.6% anthracycline-taxane based combination regimen and 83.3% taxane based regimen. Stage factors increased the risk 9-fold (HR 9.602) and chemotherapy delay increased the 5-fold (HR 5,576) risk of survival. Combination regimens of anthracycline-taxane based and taxane based can be used for therapeutic modalities of breast cancer patients. 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Clinical and Subtypes of Breast Cancer in Indonesia. Asian Pacific Journal of Cancer Care, 5 (4) : 281-285. Zheng, R., Han, S., Duan, C., Chen, K., You, Z., Jia, J., Lin, S., Liang, L., Liu, A., Long, H. & Wang, S. 2015. Role of taxan and antrasiklin combination regimens in the management of advanced breast cancer: a meta-analysis of randomized trials. Medicine : 94(17). Zubair, M., Wang, S., & Ali, N. 2021. Advanced Approaches to Breast Cancer Classification and Diagnosis. Front Pharmacol. 11 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3841276","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":268537955,"identity":"68927171-f18b-4424-80ef-f0794c02286d","order_by":0,"name":"Yulistiani 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survival graph of breast cancer patients (n=71)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3841276/v1/eac22e0dc350ad7ff0207d94.jpg"},{"id":50055226,"identity":"3f71900c-644b-4d85-91bc-f3cb8e7b13c2","added_by":"auto","created_at":"2024-01-23 17:35:29","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36898,"visible":true,"origin":"","legend":"\u003cp\u003eGraph of 2-year survival of breast cancer patients based on chemotherapy delay (n=71)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3841276/v1/dc14a6873d108b661dbf5fb9.jpg"},{"id":50054931,"identity":"218f4429-12d3-4c40-ae12-1542cf0f7e38","added_by":"auto","created_at":"2024-01-23 17:27:29","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":35859,"visible":true,"origin":"","legend":"\u003cp\u003e2-year survival graph of breast cancer patients by stage (n=71)\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3841276/v1/4af9c4799908fba6633e3cd2.jpg"},{"id":58027054,"identity":"1225ee86-a945-40c5-8a04-28583209ea57","added_by":"auto","created_at":"2024-06-10 06:55:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":897649,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3841276/v1/7dfd15b2-a2a0-42e9-a736-280e7d7bbcf1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAnalysis of Chemotherapy Regimens on Survival Rate of Breast Cancer Patients\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBreast cancer is a group of diseases that cause abnormal changes and divisions in cells within the breast tissue usually resulting in lumps or masses (ACS, 2019). Breast cancer is among the most commonly diagnosed cancers in women worldwide with more than 2\u0026nbsp;million new cases (11.7%) in 2020. Breast cancer mortality in the world in 2020 reached 684,996 (6.9%) (WHO, 2020).\u003c/p\u003e \u003cp\u003e According to data from Global Cancer Statistics (2020), in Indonesia breast cancer ranks first with the highest number of new cases of cancer and is the second contributor to cancer mortality after lung cancer. The number of new cases amounted to 65,858 or 16.6% of the 396,914 new cases of cancer in Indonesia with a mortality rate of 22,430 cases. The incidence rate in Indonesia is estimated at 44/100,000 women (WHO, 2020). Breast cancer patients in Indonesia are recorded as having the highest number of stage IIIB included in the advanced stage (Widiana \u003cem\u003e\u0026amp;\u003c/em\u003e Irawan, 2020).\u003c/p\u003e \u003cp\u003eThe principle of treatment of advanced breast cancer is palliative therapy with systemic therapy which is the primary therapy (chemotherapy and hormonal therapy) if necessary can use radiation therapy and surgery (Kemenkes, 2018). Cancer chemotherapy can be a combination of several drugs (chemotherapy regimens) with the aim of killing cancer cells (Arianto, 2017). Research by Rossi \u003cem\u003eet al.\u003c/em\u003e, (2015) demonstrated the benefits of chemotherapy administration. The study involved invasive breast cancer patients stating overall survival (OS) in the no-chemotherapy group compared to the chemotherapy group of 87.6% versus 92.1% (5 years) and 75.0% versus 81.9% (10 years), respectively. The extrapolated data showed that chemotherapy lowered the relative risk of death by 25% (HR\u0026thinsp;=\u0026thinsp;0.75) and the relative risk of metastasis by 18% (HR\u0026thinsp;=\u0026thinsp;0.82). These results are supported by a study by Bonadonna \u003cem\u003e\u0026amp;\u003c/em\u003eValagussa, (1981) which was the first to show that the full dose group of chemotherapy (\u0026amp;gt; 85%) cyclophosphamide, methotrexate and 5-fluorouracil (CMF) provided disease free survival (DFS) of 77% compared to the group treated with only radical mastectomy i.e. 45%.\u003c/p\u003e \u003cp\u003eThe following study states the superiority of anthracyclines and taxane-containing regimens (adriamycin, cyclophosphamide followed by taxanes) achieving the greatest risk reduction in breast cancer (Waks \u003cem\u003e\u0026amp;\u003c/em\u003e Winer, 2019; Krajc \u003cem\u003eet al.\u003c/em\u003e, 2020). A meta-analysis study from the Early Breast Trialist's Collaborative Group (EBTCG) is comparing between CMF and anthracycline-based regimens. Better results were observed on anthracycline-based regimens compared to CMF which could reduce recurrence rates by 11% and reduce breast cancer mortality rates by 16%. The combination of docetaxel or paclitaxel with anthracycline leads to improved outcomes in advanced stages (\u003cem\u003eEstevez et al.\u003c/em\u003e, 2007).\u003c/p\u003e \u003cp\u003ePrevious studies by Romadhon \u003cem\u003eet al.\u003c/em\u003e, (2021) have examined the relationship between plasma levels of miRNA-21 and overall survival rate as a prognostic factor in breast cancer at Airlangga University Hospital. However, based on a search of the current library, research on the analysis of chemotherapy regimens for survival in breast cancer patients housed in Airlangga University Hospital has not been conducted. Survival analysis includes metrics for assessing disease mortality and morbidity, survival rates related to risk factors and success of cancer treatment therapies (Dwidayati, 2012; Romadhon \u003cem\u003eet al.\u003c/em\u003e, 2021).\u003c/p\u003e \u003cp\u003eThe difference in therapeutic outcomes shows the importance of choosing the right regimen for breast cancer patients. Choosing the right regimen is expected to support improved patient survival. The study provides an overview of survival information through the Kaplan-Meier curve as well as the factors that are thought to affect survival obtained at hazard ratio values. Based on this description, the aim of this study was to analyze chemotherapy regimens in breast cancer patients at Airlangga University Hospital who used anthracycline-taxane-based combination regimens and taxane-based regimens for survival and to identify factors that may influence it including age, stage, comorbidity/complications, and chemotherapy delay.\u003c/p\u003e"},{"header":"RESEARCH METHOD","content":"\u003cp\u003eThe method of this study was an analytic observational study using a cohort retrospective method with quantitative analysis. The research was conducted at the Integrated Oncology Installation of Airlangga University Hospital. The study population was all patients with advanced breast cancer who were first diagnosed on January 1st, 2018 \u0026mdash; August 30th, 2022 and received chemotherapy treatment at Airlangga University Hospital. The samples in this study were all breast cancer patients who had undergone chemotherapy since the first chemotherapy administration who met the inclusion criteria using the time-limited sampling method. The inclusion criteria of this study include 1) breast cancer patients\u0026thinsp;\u0026gt;\u0026thinsp;18 years of age who were first diagnosed with or without comorbidities, receiving anthracycline and/or taxane based chemotherapy treatment at Airlangga University Hospital, 2) patients with complete medical records including identity, diagnosis, cytostatic drug therapy, clinical data, laboratory data, date of visit. The exclusion criterias of this study were 1) the patient was referred to another hospital, 2) the patient was male. All patients\u0026rsquo; data for this study were collected from patients\u0026rsquo; medical records and remain anonymized before and after data collection. The study was approved by the Research Ethics Committee of Rumah Sakit Universitas Airlangga and was declared to have passed the ethical review with a Certificate of the Ethics Review Approval Number 066/KEP/2023. Due to the retrospective nature of the study, the need of informed consent was waived by Research Ethics Committee of Rumah Sakit Universitas Airlangga. We confirm that all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe characteristics of the patient distribution are presented in tables using crosstab and chi-square assays between the characteristics and the patient's chemotherapy regimen. Kaplan-Meier analysis to look at survival rates which are the percentage of people in the study who lived after diagnosis or start of therapy. Along the horizontal axis (X) there are units of time and along the vertical axis (Y), it indicates the probability of survival. Interpretation of the Kaplan-Meier curve by identifying the median of survival (the time when the probability of survival reaches 50%) and seeing that curve fluctuate over time. Log-rank test is used to determine if there are differences between survival curves between groups. Cox proportional hazard regression is used to determine the factors that influence response variables such as survival time.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULT","content":"\u003cp\u003eThis study analyzed chemotherapy regimens against survival rates in breast cancer patients at Airlangga University Hospital from January 1st, 2018 to August 30th, 2022. The total number of patients who met the inclusion criteria was 76 patients. The excluded patients consisted of one male patient and four patients referred out. The total number of patients who met the inclusion and exclusion criteria in this study was 71 patients consisting of 47 patients receiving anthracycline-taxane-based combination and 24 patients receiving taxane-based chemotherapy.\u003c/p\u003e \u003cp\u003eThe characteristics of patients were grouped by age, first stage at diagnosis, comorbidities or complications, chemotherapy delay, ER receptor hormone status, PR, HER-2, chemotherapy regimen and patient survival status (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most of the patients were adults when first diagnosed which was 78.9% while the other 21.1% of patients were elderly. In this study, the first stage at diagnosis was divided into groups of initial (I and II) and advanced stages (III and IV). Early stages account for 31.0% of all patients, while advanced stages account for 69.0%. Comorbidities in this study included hypertension (25.4%), diabetes (14.1%), pneumonia (2.8%), AKI (1.4%), congestive heart failure/CHF (1.4%), bronchitis (1.4%), COVID-19 (1.4%). In addition, breast cancer cells derived from the primary tumor can spread to other organs. Metastases in this study included liver (4.2%), lung (2.8%), bone (1.4%) and cerebrum (1.4%). The group of delays of less than 14 days in the study recorded 80.3%, while delays of more than 14 days were 19.7%. The study displayed characteristics of estrogen, progesterone, and HER-2 hormone receptors found in 62 patients based on immunohistochemical examination. Immunohistochemical examination of nine patients was not attached to the medical record. A total of 66.2% of patients showed hormone receptor (ER/PR) positive results while the other 21.1% had hormone receptor (ER/PR) negative. Examinations in 52.1% of patients showed overexpression of HER-2 and 35.2% with HER-2 negative.\u003c/p\u003e \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\u003eCharacteristics of breast cancer patients in the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdult (\u0026lt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElderly (\u0026gt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean / SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11,19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdvanced Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidies/Complications\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovid-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver Metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung Metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral Metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone Metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy Delay\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eER/PR\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHER-2\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy Regimen\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnthracycline-taxane based combination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaxan-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCharacteristics based on factors assumed to affect survival in both groups of regimens were tested using crosstab and chi-square assays. The crosstab and chi-square assays explain the distribution of patient distribution in studies using anthracycline-taxane-based and taxane-based combination regimens with certain characteristics. Catacteric by group regimen are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Chi-square test results of age group, stage, comorbidies/complications, delay of chemotherapy therapy showed no significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This shows that the sample data is evenly distributed among the groups.\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\u003eCharacteristics of factors based on chemotherapy regimens\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Chemotherapy Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003cem\u003e-Value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnthracycline-taxane based combination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaxan based\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdult (\u0026lt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElderly (\u0026gt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidies/Complications\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy Delay\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAn analysis of overall breast cancer patients\u0026rsquo; survival is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The decreased Kaplan-Meier survival curve was due to the presence of events (mortality) during the study period. A positive sign describes the censored data over the observation period. The one-year and two-year survival curves of Kaplan-Meier breast cancer patients at Airlangga University Hospital are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The 1-year and 2-year survival percentages for anthracycline-taxane based combinations were 93.6% and taxane-based 83.3%. A log rank test showed that the two regimens did not differ significantly in terms of survival percentage (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The results of the analysis of the survival of breast cancer patients can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Median survival in this study could not be assessed because in both groups of the regimens, 50% of patients had not died. Median survival is the time at which 50% of patients experience an event or mortality.\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\u003eSurvival rate results from Kaplan-Meier analysis\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime/Length\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSurvival Rate\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLog-rank\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnthracycline-taxane based combination (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaxan based\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91,5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83,3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93,6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83,3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93,6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83,3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCox proportional hazard regression analysis was performed to look at the factors that influence the survival parameters. The characteristics of ER/PR and HER-2 are included in this test. Bivariate analysis on predictor variables was using cox propotional hazard regression. Variables with p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 in bivariate analysis were then multivariate tested to determine their effects simultaneously. The results of the Cox regression analysis of these factors in breast cancer patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Chemotherapy stage and delay factors were significant factors affecting survival in multivariate analysis with significance of p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, respectively. Multivariate analysis showed that increased stage can increase the risk of mortality by 9 times based on the hazard ratio obtained (HR 9.602; 95% CI 1.602\u0026ndash;57.536; p\u0026thinsp;=\u0026thinsp;0.013). Other factors such as chemotherapy delay were among the factors that significantly influenced survival in this study (HR 5.576; 95% CI 1.16\u0026ndash;27.850; p\u0026thinsp;=\u0026thinsp;0.036). Based on the hazard ratio, a delay of chemotherapy\u0026thinsp;\u0026gt;\u0026thinsp;14 days can increase the risk of mortality by up to 5 times.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors affecting survival of 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdult (\u0026lt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (78,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElderly(\u0026gt;\u0026thinsp;60 tahun)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (21,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,538 (0,066\u0026thinsp;\u0026minus;\u0026thinsp;4,380)\u003c/p\u003e \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\u003e\u003cb\u003eStage (n\u0026thinsp;=\u0026thinsp;71)\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 \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 \u003cp\u003e4 (5,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16,729 (3,35\u0026ndash;79,163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,001\u003c/p\u003e \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 \u003cp\u003e18 (25,4)\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\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (53,5)\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\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (15,5)\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\u003e\u003cb\u003eComorbidies/Complications (n\u0026thinsp;=\u0026thinsp;71)\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 \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\u003e45 (63,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,034\u003c/p\u003e \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\u003e26 (36,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,640 (1,137\u0026thinsp;\u0026minus;\u0026thinsp;27,977)\u003c/p\u003e \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\u003e\u003cb\u003eChemotherapy Delay (n\u0026thinsp;=\u0026thinsp;71)\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (80,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (19,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,140 (1,937\u0026thinsp;\u0026minus;\u0026thinsp;34,215)\u003c/p\u003e \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\u003e\u003cb\u003eER/PR (n\u0026thinsp;=\u0026thinsp;62)\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (24,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (75,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,399 (0,066\u0026thinsp;\u0026minus;\u0026thinsp;2,416)\u003c/p\u003e \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\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (12,7)\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\u003e\u003cb\u003eHER-2 (n\u0026thinsp;=\u0026thinsp;62)\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (40,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (59,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,959 (0,160-5,757)\u003c/p\u003e \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\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (12,7)\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 \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analysis of various factors related to survival of breast cancer patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage\u003c/p\u003e \u003cp\u003eComorbidies/Complications Chemotherapy Delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,602 (1,602\u0026thinsp;\u0026minus;\u0026thinsp;57,536)\u003c/p\u003e \u003cp\u003e2,260 (0,346\u0026thinsp;\u0026minus;\u0026thinsp;14,760)\u003c/p\u003e \u003cp\u003e5,576 (1,116\u0026thinsp;\u0026minus;\u0026thinsp;27,850)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,013\u003c/p\u003e \u003cp\u003e0,394\u003c/p\u003e \u003cp\u003e0,036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatient survival curves based on stage and delay of chemotherapy are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The observed probability of survival in the group of patients without delay of chemotherapy (\u0026lt;\u0026thinsp;14 days) reached 96.5% while in the group\u0026thinsp;\u0026gt;\u0026thinsp;14 days it was 64.3%. In this study, the probability of survival decreased with increasing stage. 2-year survival in stage I and stage II patients reached 100%, stage III 97.4% and stage IV 45.5%.\u003c/p\u003e \u003cp\u003eBreast cancer patients undergoing chemotherapy often experience side effects after undergoing chemotherapy. This relates to the delay of chemotherapy which can affect the progression of a patient's cancer as well as the patient's acceptance of chemotherapy. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows both regimens had similar side effects. The anthracycline-taxane-based combination regimen has a higher effect on nausea, vomiting, fever, dizziness, neutropenia and itching. More side effects occur with the taxane-based regimen in the form of diarrhea, tingling, decreased appetite and constipation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSide effects of chemotherapy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSide Effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnthracycline-taxane based combination (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaxan based (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea-vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41,67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTingling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33,33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16,67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutropenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased Appetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSurvival analysis using Kaplan-Meier method aims to look at the survival of patients with survival percentage parameters. The results of the observations were plotted on the survival curve. The log-rank test was performed after the Kaplan-Meier survival curve results were established to compare whether there was a difference between the survival curves of the two groups of regimens. In addition, an analysis was carried out on factors that were assumed to affect survival. Side effects that occured during the course of a patient undergoing chemotherapy treatment were treated descriptively.\u003c/p\u003e \u003cp\u003eThe one-year and two-year survival percentages of anthracycline-taxane based combinations were 93.6% and taxane-based 83.3% (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Based on these data, taxane-anthracycline based combination regimens have a greater probability of survival than taxane-based, but not statistically significant. This is similar to a meta-analysis study by Zheng \u003cem\u003eet al.\u003c/em\u003e, (2015), which compared the benefits of using a combination of anthracyclines along with taxanes versus a single agent-based chemotherapy regimen. The results showed that chemotherapy with a combination of anthracycline and taxane did not significantly improve OS of breast cancer patients when compared to OS achieved using taxane or anthracycline single agents (Zheng \u003cem\u003eet al.\u003c/em\u003e, 2015).\u003c/p\u003e \u003cp\u003eSeveral other studies compared combination versus taxane-based regimens in breast cancer patients. Caparica \u003cem\u003eet al\u003c/em\u003e. (2018), in their systematic review and meta-analysis study comparing taxan-based regimens versus anthracycline- and taxane (AT) -based regimens in the treatment of breast cancer. Overall, no difference was observed between taxane-based and AT regimens against OS (HR 1.05; 95% CI 0.90\u0026ndash;1.22). The incidence of nausea, vomiting, mucositis and thrombocytopenia significantly occurred in the combination regimen (Caparica \u003cem\u003eet al\u003c/em\u003e., 2018).\u003c/p\u003e \u003cp\u003eThe Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2023), noted that no significant reduction in the risk of recurrence was found for taxane and anthracycline administration when compared to docetaxel plus cyclophosphamide (RR 0.94; 0.83\u0026mdash;1.06; p\u0026thinsp;=\u0026thinsp;0.30). Therefore, the results of this study have shown the same results as previous studies. A meta-analysis of EBCTCG showed that anthracycline-containing and taxane-containing chemotherapy reduced the 10-year mortality rate of breast cancer by about a third. Four doses of anthracycline followed by four doses of docetaxel were as effective as the same drug combination, six times TAC but had different toxicity patterns. TAC requires granulocyte support due to high rates of neutropenic fever (Harbeck \u0026amp; Gnant, 2017).\u003c/p\u003e \u003cp\u003eTaxans (paclitaxel and docetaxel) work by inhibiting microtubule dynamics that form microtubule polymerization as well as inhibiting depolymerization and resulting in cell cycle termination in G2 and M phases leading to cancer cell death (Basuki \u003cem\u003eet al\u003c/em\u003e., 2020; Hassanzadeh \u003cem\u003eet al\u003c/em\u003e., 2018). Paclitaxel and docetaxel are administered intravenously. Taxanes are metabolized by P450 in the liver with \u0026gt;\u0026thinsp;90% bound to plasma proteins. About 70% \u0026minus;\u0026thinsp;80% of the drug is excreted through the feces, while through the kidneys a relatively small less than 10% (Chu \u0026amp; Devita, 2019).\u003c/p\u003e \u003cp\u003eThe cytotoxic mechanism of anthracycline works by causing damage to the cell's DNA. Two major mechanisms are involved in anthracycline's toxic effects on cells. The anthracycline compound has a structure that allows it to fit into the DNA strand by interacting non-covalently resulting in anthracyclines being intercalated between DNA base pairs. This leads to disruption of the process of cell DNA synthesis. In addition anthracycline inhibits topoisomerase, which is an enzyme that opens the double strand of DNA in order for it to be replicated and synthesized. By disrupting the function of topoisomerase, anthracycline causes the cessation of cell growth and leads to apoptosis. Anthracyclines also form free radicals (ROS) that can cause single- and double-stranded DNA damage (Geisberg \u0026amp; Sawyer, 2010).\u003c/p\u003e \u003cp\u003eThe structure of anthracyclines is formed from anthraquinones bound to aminoglycosides (Corremans \u003cem\u003eet al.\u003c/em\u003e, 2018). Anthracycline is administered intravenously because it has low intestinal solubility and permeability and a high intestinal first-pass effect (Lee \u003cem\u003eet al.\u003c/em\u003e, 2023). About 75\u0026ndash;80% of anthracyclines and their metabolites are bound to plasma proteins. Anthracycline is metabolized in the liver to active metabolites. About 40\u0026ndash;50% excretion is through the fecal with less than 10% by the kidneys. Anthracycline has a higher risk of cardiotoxicity in patients\u0026thinsp;\u0026gt;\u0026thinsp;70 years of age, in patients with a history of hypertension or heart disease. This is largely due to the mechanism of doxorubicin free radical formation (Chu \u0026amp; Devita, 2019). The main mechanism of doxorubicin cardiotoxicity is the increased oxidative stress shown from increased reactive oxygen levels of the species and lipid peroxidation (Chatterjee \u003cem\u003eet al.\u003c/em\u003e, 2010).\u003c/p\u003e \u003cp\u003eFurther analysis was performed on the Cox proportional hazard regression test to determine the factors that affect the survival of breast cancer patients. Bivariate analysis shows that stage factors, presence of comorbidies/complications and chemotherapy delay of \u0026gt;\u0026thinsp;14 days may affect survival. Simultaneous multivariate analysis showed that the stage factor increased the risk nine times based on the hazard ratio obtained from the Cox regression test (HR 9.602; 95% CI 1.602\u0026ndash;57.536; p\u0026thinsp;=\u0026thinsp;0.013). 2-year survival in stage I and stage II patients reached 100%, stage III 97.4% and stage IV 45.5%. Another significant factor in the multivariate analysis was that chemotherapy delay increased 5-fold the risk of survival (HR 5.576; 95% CI 1.16\u0026ndash;27.850; p\u0026thinsp;=\u0026thinsp;0.036). The probability of survival in the group of patients without delay of chemotherapy (\u0026lt;\u0026thinsp;14 days) was 96.5% while in the group\u0026thinsp;\u0026gt;\u0026thinsp;14 days it was 64.3%.\u003c/p\u003e \u003cp\u003eThis shows that increased stages can affect survival probability as in Alkabban \u0026amp; Ferguson (2022), stated that stage 0 and stage I had a 5-year survival rate of 100%. The 5-year survival rate for stage II and stage III breast cancer was approximately 93% and 72%, respectively. Systemic or stage IV spread of cancer caused the prognosis to deteriorate to 22% for 5-year survival. An estimated 20\u0026ndash;30% of early-stage breast cancers metastasized to an advanced stage. A total of 6\u0026ndash;10% of women with breast cancer in the United States was found to have stage IV disease at diagnosis (Wang \u003cem\u003eet al.\u003c/em\u003e, 2019). Early detection efforts were very important because if breast cancer could be detected at an early stage and treated appropriately, the cure rate was quite high (80\u0026ndash;90%). Early detection of breast cancer aims to detect and identify the presence of breast cancer early, so that patients receive therapy with a greater chance of cure (Kemenkes, 2013).\u003c/p\u003e \u003cp\u003eModification of the chemotherapy schedule increases the duration between cycles of chemotherapy, which consequently reduces the intensity of the treatment dose. Cytotoxic antitumor activity depends on the drug used and on the schedule of drug administration. Based on previous studies, cumulative delays of \u0026ge;\u0026thinsp;14 days significantly increased mortality by 2.56 times (HR 2.56; p\u0026thinsp;=\u0026thinsp;0.030) (Gunasekaran \u003cem\u003eet al\u003c/em\u003e., 2020). Another study reported a delay variable in the administration of anthracycline-based chemotherapy with the number of days of delay of more than 14 days or a delay in two cycles of chemotherapy can have a lower probability of survival without recurrence of the disease for ten years (Chirivella \u003cem\u003eet al\u003c/em\u003e., 2009). Hence, the duration of delay between cycles should be reduced whenever possible in order to achieve maximum chemotherapy benefits (Chirivella, 2009; Gunasekaran \u003cem\u003eet al\u003c/em\u003e., 2020).\u003c/p\u003e \u003cp\u003eThe results of multivariate cox regression analysis showed that comorbidities/complications were not a significant factor affecting survival. Comorbid is a condition accompanied by other systemic diseases or complications of breast cancer that spreads to other organs. These results are in line with studies by Netchuta \u003cem\u003eet al\u003c/em\u003e showing that none of the comorbidities (comorbidities) studied (hypertension, chronic gastritis, diabetes mellitus, chronic bronchitis/asthma, CHD, stroke, chronic hepatitis and rheumatoid arthritis) significantly affect the risk of breast cancer recurrence (Netchuta \u003cem\u003eet al\u003c/em\u003e., 2013).\u003c/p\u003e \u003cp\u003eTests on age factors, and characteristics of ER/PR and HER-2 showed no significant differences in bivariate and multivariate assays. This indicates that these variables were not statistically significant. A study by Mirsyad \u003cem\u003eet al.\u003c/em\u003e (2022), breast cancer patients at Makassar Ibnu Sina Hospital showed that there was no significant relationship between patient age and clinical stage level (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Patients' awareness of early examination/early detection also influences the patient's cancer stage (Mirsyad \u003cem\u003eet al\u003c/em\u003e., 2022).\u003c/p\u003e \u003cp\u003eThe characteristics of ER/PR and HER-2 were carried out through medical records. Estrogen receptors or progesterone receptors are proteins found on the surface of breast cancer cells. When estrogen or progesterone binds to its receptors, this can activate signaling pathways that promote breast cancer cell growth (Oza \u0026amp; Ma, 2017, Hart \u003cem\u003eet al\u003c/em\u003e., 2020; Li \u003cem\u003eet al\u003c/em\u003e., 2022). ER/PR positive cancer cells are sensitive to the presence of the hormones estrogen and progesterone. Cancer cells of this type are sensitive to hormonal therapy and have better cure rates compared to cancer cells that have neither estrogen receptors nor progesterone receptors (Kristian \u0026amp; Sandhika, 2021). Breast cancer cells with a positive HER-2 test result will be sensitive to anti-HER-2 monoclonal antibody therapy. In addition, it also has a high cell proliferation rate so that the cancer is more sensitive to chemotherapy (Kristian \u0026amp; Sandhika, 2021; Wawruszak \u003cem\u003eet al\u003c/em\u003e., 2021).\u003c/p\u003e \u003cp\u003eA study by Kristian \u0026amp; Sandhika (2021), concluded that the increased degree of differentiation in cancer cells (grade) would be followed by a decrease in estrogen receptors and progesterone receptors in cancer cells, but there was no correlation between HER-2 examination results and the degree of histological differentiation of breast cancer cells. This shows that lower grade cancer cells have properties that are more similar to normal cells: they have estrogen and progesterone receptors and thus have lower cell growth rates compared to higher grade breast cancers that lose estrogen and progesterone receptors. HER-2 having no correlation with the degree of histological differentiation of cancer cells means that HER-2 can be possessed by breast cancer cells with varying degrees of malignancy (Kristian \u0026amp; Sandhika, 2021).\u003c/p\u003e \u003cp\u003eIn addition to factors that affect survival, the presence of incidences or events of adverse events is also an important factor affecting the quality of life of patients undergoing chemotherapy (Matwin \u003cem\u003eet al.\u003c/em\u003e, 2021). In this study, due to the limited number of samples, there was no further statistical analysis could be performed. However, the data were descriptively processed to see the mean and day range of chemotherapy delays in breast cancer patients receiving anthracycline-taxane-based combination regimens and those receiving taxane-based regimens.\u003c/p\u003e \u003cp\u003eThe most common side effects judging by the percentage incidence of anthracycline-taxane-based combination regimens were nausea, vomiting (34%), diarrhea (29.55%), tingling (22.73%), fever (18.18%), and dizziness (13.64%). The use of the taxane-based regimen hasd almost the same side effects as the combination regimen, most of which included diarrhea (41.67%), tingling (33.33%), nausea vomiting (25%), fever (16.67%), neutropenia (8.33%). These results are in line with studies from Capatirca \u003cem\u003eet al.\u003c/em\u003e, (2018) which concluded emesis/vomiting, mucositis and thrombocytopenia were significantly more frequent with anthracycline alongside taxanes. The effects of fatigue and nausea were the most frequently reported nonhematologic toxicities in the first cycle (Gadisa \u003cem\u003eet al.\u003c/em\u003e, 2020). The same results were shown by the meta-analysis study of Zheng \u003cem\u003eet al\u003c/em\u003e. (2015), which stated that taxane-based regimens had lower side effects in the form of neutropenia, infection/fever, nausea, and vomiting, but higher for hand-foot syndrome and diarrhea.\u003c/p\u003e \u003cp\u003eIn general, all chemotherapy drugs are at risk of causing nausea/vomiting, as they can damage the gastrointestinal tract and cause enterochromaffin cells present in the digestive tract especially in the small intestine to release nerve signals through the release of neurotransmitters, namely serotonin (5-HT). These neurotransmitters then activate the afferent fibers of the sarafvagus by binding to 5-HT3 receptors which then stimulate the dorsal complex of the vagus nerve, the chemoreceptor trigger zone, to trigger the motor response of nausea and vomiting (Kholida \u003cem\u003eet al.\u003c/em\u003e, 2020).\u003c/p\u003e \u003cp\u003eDiarrhea was the most common side effect found with the use of taxane-based regimens. The cytotoxic mechanism of paclitaxel stabilized the polymer structure of microtubules and inhibits depolymerization of microtubules back to tubulin. This process inhibited free tubulin and created an inefficient array of irregular microtubules for cell replication, thereby blocking mitosis. The toxic effect of paclitaxel was most pronounced on tissues with rapid cell turnover, including hematopoietic, lymphatic, gastrointestinal (GI), and reproductive tissues, as well as tissues affected by alopecia. Studies had identified neutropenia, neuropathy, mucositis, asymptomatic bradycardia, myalgia, arthralgia and diarrhea as major side effects of paclitaxel therapy (Ismail \u0026amp; Killeen, 2023).\u003c/p\u003e \u003cp\u003eThe side effects experienced by the patient became one of the causes of the delay until the discontinuation of the patient's chemotherapy which would have an impact on the progression of the disease. Additionally, observation of adverse events was important in improving the patient's quality of life making it necessary to monitor and alert pharmacists to these ESO events.\u003c/p\u003e \u003cp\u003eThe limitation in this study is to analyze the short-term viability (1 year and 2 years) only due to limitations in the study period. The next study is expected to analyze the medium term (3 years) and long-term (5 years) survival of breast cancer patients. In addition, other studies related to the cost aspects of treatment and observations on combinations of other types of therapy are needed so that comprehensive treatment results can be achieved. Addressing the side effects of therapy also improves quality of life, so further research is expected to focus on post-chemotherapy side effects of breast cancer.\u003c/p\u003e"},{"header":"CONCLUSION AND SUGGESTION","content":"\u003cp\u003eThe survival rate of one year and two years in breast cancer patients who received treatment at Airlangga University Hospital with a 93.6% anthracycline-taxane based combination regimen and 83.3% taxane based regimen. Stage factors increased the risk 9-fold (HR 9.602) and chemotherapy delay increased the 5-fold (HR 5,576) risk of survival. Combination regimens of anthracycline-taxane based and taxane based can be used for therapeutic modalities of breast cancer patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYulistiani, Febriansyah Nur Utomo, Pradana Zaky Romadhon, and Nisriyati Fiddina wrote the main manuscript text, prepared the tables and figuresAll Authors reviewed the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eACS. 2019. \u003cem\u003eBreast Cancer Facts \u0026amp; Figures 2019-2020\u003c/em\u003e. American Cancer Society, Atlanta.\u003c/li\u003e\n\u003cli\u003eAlkabban, F.M \u0026amp; Ferguson, T. 2022. \u003cem\u003eBreast Cancer.\u003c/em\u003e StatPearls Publishing. PMID: 29493913.\u003c/li\u003e\n\u003cli\u003eArianto, R.P., Agustina, R. \u0026amp; Fadraersada, J. 2017. 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Advanced Approaches to Breast Cancer Classification and Diagnosis. \u003cem\u003eFront Pharmacol. 11\u003c/em\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, chemotheraphy, anthracycline, taxane, survival rate","lastPublishedDoi":"10.21203/rs.3.rs-3841276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3841276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBreast cancer in Indonesia is among the first with the highest number of new cancer cases with the second mortality in cancer after lung cancer in 2020. Anthracycline-taxane based regimens and taxane-based regimens are often breast cancer chemotherapy modalities that can support increased patient survival. Side effects occur more frequently in combination regimens. The selection of the right regimen is expected to support the improvement of patient survival. This study aims to analyze the survival rate of chemotherapy regimen groups and hazard ratio factors that are thought to affect survival in breast cancer patients. This study used an observational and retrospective cohort method. The statistical analyzes used in this study include Kaplan-Meier analysis to measure survival rates, Log-rank test to observe the differences between regimen groups and Cox proportional hazards regression to analyze factors that influence survival. Patients who were included in the inclusion and exclusion criteria were 71 patients, consisting of 47 patients who received anthracycline-taxane based combination and 24 patients who received taxane-based chemotherapy. The percentage of one-year and two-year survival in the anthracycline-taxane based combination was 93.6% and taxane-based 83.3% (p\u0026gt;0.05). Multivariate analysis showed that stage increased risk 9 times based on hazard ratio values obtained from cox regression tests (HR 9.60; 95% CI 1.60-57.54; p\u0026lt;0.05). Another significant factor in the multivariate analysis was that delaying chemotherapy increased the risk of survival 5 times (HR 5,58; CI 95% 1.12-27.85 ; p\u0026lt;0.05). Based on research, it can be concluded that anthracycline-taxane based and taxane based combination regimens can be used as a treatment modality for breast cancer patients in both early and advanced stages.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Analysis of Chemotherapy Regimens on Survival Rate of Breast Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-23 17:27:24","doi":"10.21203/rs.3.rs-3841276/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a888f348-815c-45d4-9bd5-ea6169386169","owner":[],"postedDate":"January 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28325192,"name":"Biological sciences/Cancer"},{"id":28325193,"name":"Biological sciences/Cancer/Breast cancer"},{"id":28325194,"name":"Biological sciences/Cancer/Cancer therapy"}],"tags":[],"updatedAt":"2024-06-10T06:47:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-23 17:27:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3841276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3841276","identity":"rs-3841276","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}