Treatment of stage I breast cancer (T1N0M0): A long-term follow-up study

Abstract

11509 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 early breast cancer within our institution. Methods: Between January 1978 and December 2006, 251 women with T1N0M0 (AJCC) breast cancer were identified. Tumor size was determined from the pathology report. 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 the 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 the log-rank test. Results: The median age at the time of diagnosis was 52 years (28–84). Conservative surgery was performed in 92% of patients (pts) and 98% underwent nodal dissection. The median number of nodes examined was 18.5. ER was positive in 74% of pts and PR was positive in 66%. Adjuvant radiation therapy was administered to 89% of pts whereas adjuvant chemotherapy and/or hormone therapy were given to 59% and 72%, respectively. The median follow-up was 91 months (7–325). Local recurrence was documented in 8 pts (3.1%). Twenty-two pts developed distant recurrence (8.7%). Bilateral breast cancer was seen in 5 cases (2%). Nine pts (3.5%) developed 2nd malignancies. RFS rate at 10 and 15 years was 84.6% and 72.6%, respectively. OS at 5, 10 and 15 years was 96%, 84% and 74%, respectively. Factors that had an effect in OS demonstrated by the multivariate regression analysis were primary tumor size, age and family history of cancer (p < 0.03). Conclusions: Clinical outcomes of stage I breast cancer in our practice is similar to that reported in international literature. This group of pts continues to have an excellent prognosis as shown by the OS rate at 5, 10 and 15 years, although high percentage of pts continue to have recurrence and die from breast cancer after 5, 10 and 15 years of follow-up. No significant financial relationships to disclose.