Factors associated with late risks of breast cancer-specific mortality in the SEER registry

Eric P Winer,Noah Graham,Carlos T Vallejo,Rachel A Freedman,Sara M Tolaney,Nabihah Tayob,Michael J Hassett,José P Leone,Bernardo A Leone,Julieta Leone,Nancy U Lin

doi:10.1007/s10549-021-06233-4

Eric P Winer, Noah Graham + Show 9 more

Open Access

https://doi.org/10.1007/s10549-021-06233-4

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Abstract

PurposeMost reports describing the risk of late relapse in breast cancer (BC) have been based on selected patients enrolled into clinical trials. We examined population-based long-term risks of BC-specific mortality (BCSM), the risks of BCSM conditional on having survived 5 years, and factors associated with late BCSM.MethodsUsing SEER, we identified women diagnosed with BC (T1-T2, N0-N2, M0) between 1990 and 2005 with known hormone receptor (HR) status. Kaplan–Meier analyses determined cumulative risks of BCSM. We performed Fine and Gray regression stratified by HR status.ResultsWe included 202,080 patients (median follow-up of 14.17 years). Of all BC deaths, the proportion that occurred after 5 years was 65% for HR-positive vs 28% for HR-negative (p < 0.001) BC. In HR-positive BC, the cumulative risks of BCSM during years 5–20 were 9.9%, 21.9%, and 38% for N0, N1, and N2 disease. For HR-negative BC, the risks were 7.9%, 12.2%, and 19.9%, respectively. For T1a/b, N0, HR-positive BC, the risk of BCSM was 6 times lower than the risk of non-BCSM. In N2, HR-positive BC, the risk of BCSM was 43% higher than the risk of non-BCSM. In adjusted Fine and Gray models stratified by HR status, the risks of BCSM conditional on having survived 5 years for both HR-positive and HR-negative depended on T-N status, age, and year of diagnosis. In HR-positive, the risks also depended on race and grade.ConclusionThe risks of BCSM beyond 5 years, although different, remain important for both HR-positive and HR-negative BC. Strategies to prevent early and late recurrences are warranted.

Highlights

Breast cancer is the most frequent malignancy and the leading cause of cancer-related death in women, representing approximately 25% of all malignancies and 15% of cancerrelated deaths in the world [1, 2]
Most studies reporting on the risk of late recurrence in breast cancer have been based on selected patients enrolled into clinical trials, and population-based assessments of the risks of long-term breast cancer-specific mortality (BCSM) are lacking [9, 10, 19]
We evaluated non-BCSM for various subgroups of patients and estimated cumulative risk from year 5 to 20 (Table 2, Supplemental Figure 3a-c)

Summary

Introduction

Breast cancer is the most frequent malignancy and the leading cause of cancer-related death in women, representing approximately 25% of all malignancies and 15% of cancerrelated deaths in the world [1, 2]. Most studies reporting on the risk of late recurrence in breast cancer have been based on selected patients enrolled into clinical trials, and population-based assessments of the risks of long-term breast cancer-specific mortality (BCSM) are lacking [9, 10, 19]. Studies evaluating this phenomenon have focused primarily on HRpositive breast cancer and less is known about longer term. The aims of this study were to report on population-based long-term risks of BCSM across HR-positive and HR-negative subtypes, and the risks of BCSM conditional on having survived 5 years. Having more accurate estimates of the risks of late recurrence and long-term BCSM may inform clinical counseling in current breast cancer survivors and support the conceptual and statistical design of clinical trials focused on mitigating the risk of late recurrence

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