Predictors of progression, survival, and psychosocial burden in early-stage breast cancer: A real-world cohort study.

e12761 Background: While early-stage breast cancer is associated with high survival rates, recurrence risk and long-term psychosocial morbidity vary widely. Treatment-related factors, such as surgical timing, and procedure type, may influence both oncologic and quality-of-life outcomes. We conducted a real-world analysis to evaluate predictors of progression, survival, and treatment-related morbidity in early-stage breast cancer. Methods: We queried the TriNetX, a US Nationwide de-identified database, to identify female patients above 18 years old with Stage I or II breast cancer. Propensity score matching was performed across cohorts defined by demographics and comorbidities. Outcomes included all-cause mortality, disease progression, lymphedema, chronic pain, depression and anxiety. Odds ratios (OR) and 95% confidence intervals (CI) were calculated over a follow up period from 1 year post-operation to death or loss of follow up. Results: Overall, Stage I patients had significantly lower all-cause mortality (OR 0.30, 95% CI 0.24-0.36) and disease progression (OR 0.39, CI 0.31-0.49) compared to Stage II, along with lower risk of lymphedema, anxiety, and depression. Age was a significant modifier of psychosocial outcomes. Among Stage I patients, those under 50 years had lower rates of chronic pain (OR 0.45, CI 0.29-0.71) and depression (OR 0.62, CI 0.42-0.93) compared to older patients, without differences in mortality or progression. A similar trend was observed in Stage II patients, where younger age was associated with reduced anxiety (OR 0.61, CI 0.39-0.95). Delay in surgery beyond 30 days was not associated with higher mortality or disease progression in either stage. However, patients with delayed surgery in Stage I experienced significantly higher anxiety (OR 1.18, CI 1.03-1.36). Surgical type also influenced outcomes. In Stage I, mastectomy was associated with lower mortality (OR 0.25, CI 0.13-0.48) compared to lumpectomy but resulted in significantly higher rates of lymphedema (OR 2.58, CI 1.23-5.44), depression (OR 1.82, CI 1.20-2.75), and anxiety (OR 1.97, CI 1.38-2.81). A similar pattern was observed in Stage II, where mastectomy was also associated with higher rates of depression (OR 1.88, CI 1.03–3.44) and anxiety (OR 1.73, CI 1.01-2.95), along with a numerically lower, but not statistically significant mortality compared to lumpectomy. Conclusions: Mastectomy may offer survival benefit in Stage I, but is associated with increased psychological and physical complications. While Stage II disease is linked to worse cancer outcomes, decisions about surgical approach play a significant role in shaping long-term survivorship quality. These findings emphasize the need for individualized treatment strategies that weigh both clinical efficacy and long-term quality of life.