Treatment of early breast cancer (EBC): A long-term follow-up study—GOCS experience

Abstract

e11610 Background: Most cases of breast cancer are diagnosed at early stage of disease, therefore treatment is oriented to increase the relapse-free survival (RFS) and overall survival (OS). The prognosis, in comparison to other malignancies, has improved in the last decades as a result of mammographic screening. The objective of this study was to evaluate the incidence of local and distant recurrence, RFS and OS in women with EBC. Methods: From 01/1978 to 12/2004, 929 women with EBC were identified, 350 were stage I and 579 stage II (AJCC 2002). RFS was analyzed from the date of initial diagnosis to the date of local or distant recurrence. OS was estimated from the date of initial diagnosis to the last follow-up or date of death. Multivariate regression analyses were carried out using proportional hazard model proposed by Cox. RFS and OS were evaluated by the product-limit method of Kaplan and Meier, and differences between curves were assessed by means of log-rank test. Results: Median age was 51 years (28–92). Conservative surgery was performed in 69.7% of patients (pts). The median number of nodes examined was 17. Hormone receptors were ER+ in 65% and PR+ in 62% of pts. Adjuvant radiation therapy was administered to 73% of pts, whereas adjuvant chemotherapy to 29% and adjuvant hormone therapy to 18.5% of cases. Combined chemotherapy and hormone therapy was given to 34% of women. The median follow-up was 8.4 years (0.3–30). Local recurrence was documented in 37 pts (3.8%) whereas 269 developed metastatic disease (29%). Bilateral breast cancer was seen in 102 cases (10.9%) and 91 pts (9.7%) developed 2nd malignancies. RFS rate at 5, 10, 15, 20 and 25 years was 71%, 67%, 65%, 65% and 64% respectively. OS at 5, 10, 15, 20 and 25 years was 82%, 62%, 49%, 39% and 28% respectively. Factors that had an effect in OS demonstrated by the multivariate regression analysis were: histologic grade, tumor size, ER status, vascular and nodal involvement (p < 0.001). Conclusions: Clinical outcomes in EBC in our experience are similar to that reported in international literature. This group of pts continues to have a good prognosis as shown by the OS rate at 5, 10, 15, 20 and 25 years, although high percentage of pts continue to have recurrence and die from breast cancer after 5, 10, 15, 20 and 25 years of follow-up. No significant financial relationships to disclose.