High comorbidity and tumor proliferation predict survival of localized breast cancer patients after curative surgery: A retrospective analysis of real-world data in Finland.

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The aim of this study was to analyze the characteristics of breast cancer patients and their impact on real-world treatment and survival outcomes. We conducted a retrospective study including all patients newly diagnosed with breast cancer during 2019 in the Southwest Finland. We identified 458 patients diagnosed with either localized (n=435, 95%) or metastatic (n=23, 5%) breast cancer. In localized breast cancer, the five-year overall survival (OS) was 90.9%, while the five-year disease-free survival (DFS) was 93.5%. In metastatic breast cancer, the five-year progression-free survival (PFS) was 13.0% and five-year OS 34.2%. The median PFS was 10.9 months (95% CI 2.5-19.4 months) and median OS was 30.6 months (lower 95% CI 6.9 months - not reached). In the univariate analyses, the most important tumor-specific parameters predicting decreased DFS were tumor proliferation index >20%, low estrogen receptor expression status and tumor size >2cm. Univariate predictors for decreased OS included Eastern Cooperative Oncology Group (ECOG) performance status ≥2 and Charlson Comorbidity Index (CCI) score ≥3. In the multivariable analyses, CCI score ≥3 and high proliferation index (21-100% vs. 0-20%) predicted poorer DFS, while CCI score ≥3 and increased stage (stage 2 vs. 1) predicted poorer OS. The administration of post-operative radiotherapy was significant in the multivariable analyses of both DFS (HR 4.23, 95% CI 1.85-9.67, p=0.0006) and OS (HR 6.84, 95% CI 3.33-14.02, p<0.0001). Our results demonstrate that careful clinical evaluation of ECOG and comorbidities, alongside well-established tumor characteristics predict patient survival in a population where overall five-year survival in breast cancer is over 90%.