Abstract
BackgroundPopulation-based estimates of the long-term risk of loco-regional recurrence and distant metastases of breast cancer (BRC) patients are scant, as most published studies used hospital-based cohorts or participants of clinical trials. This work aims to extend available knowledge by providing population-based long-term estimates of the cumulative risk of BRC recurrence up to 10 years after diagnosis.MethodsData from the population-based Saarland Cancer Registry were used and included 9359 female patients with primary invasive BRC diagnosed between 1999 and 2009. Estimates of the cumulative incidence (CI) of BRC recurrence were derived for patients who had received local surgery with free resection margins by type of recurrence and stratified by age, tumor characteristics and major treatment options, taking into account mortality from any cause as a competing risk.ResultsThe 10-year CI of BRC recurrence was 16%. For loco-regional recurrence and distant metastases alone it was 8 and 11%, respectively. The estimates showed substantial variation and were particularly increased if tumors were advanced (T1/2N+ 23%, T3/4N0 24%, T3/4N+ 34%), of high grade (23%), or of ‘HER2/neu positive’ (28%) or ‘triple negative’ subtype (23%), respectively.ConclusionsThe derived estimates reflect the risk of ‘real world’ patients and may therefore extend available knowledge. These data are thus of great relevance for clinicians, their patients and researchers. The study likewise demonstrated the usefulness of cancer registries for a population-based monitoring of the effectiveness of cancer care in terms of disease recurrence as a major treatment related outcome measure.
Highlights
Population-based estimates of the long-term risk of loco-regional recurrence and distant metastases of breast cancer (BRC) patients are scant, as most published studies used hospital-based cohorts or participants of clinical trials
Significant proportions of patients suffer from recurrence, e.g. a trial from the US cited in clinical practice guidelines (CPG) reported occurrence of locoregional recurrence and distant metastases over 10 years in one out of every six patients and in one out of every three patients who had been diagnosed between 1975 and 1994, respectively [4]
Surrogate definitions based on immunohistochemical measurements of the expression of hormone receptors (HR), human epidermal growth factor receptor 2 (HER2/neu), and other markers such as the Ki-67 antigen are used to classify BRC and correlate well with genetically different BRC subtypes [6, 7], which are associated with the risk of recurrence and outcome in addition to classic prognostic factors [8, 9]
Summary
Population-based estimates of the long-term risk of loco-regional recurrence and distant metastases of breast cancer (BRC) patients are scant, as most published studies used hospital-based cohorts or participants of clinical trials. This work aims to extend available knowledge by providing population-based long-term estimates of the cumulative risk of BRC recurrence up to 10 years after diagnosis. Factors associated with increased risk of loco-regional recurrence include young age at diagnosis, advanced tumor size, involvement of regional lymph nodes, high grade, vascular invasion, and omitting an indicated adjuvant radiotherapy [5]. Treatment options of potentially curable loco-regional recurrence include complete surgical resection of the recurrent tumor, radiotherapy and systemic treatment based on histological examination of the cancerous tissue and re-staging. Any treatment of recurrent BRC should be based on an interdisciplinary approach [10,11,12]
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