Skip to main content

Advertisement

SpringerLink
Log in

Survival analysis according to period and analysis of the factors influencing changes in survival in patients with recurrent breast cancer: a large-scale, single-center study

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

We performed this study to analyze changing survival patterns regarding recurrent breast cancer in Korea during the last 16 years (1993–2008). We also sought to determine factors possibly influencing outcomes and changes over time in the duration of survival after recurrence.

Methods

We retrospectively analyzed 9671 patients with breast cancer treated between January 1993 and December 2008, comparing the periods 1993–2002 and 2003–2008.We retrospectively reviewed the collected database including the age at diagnosis, clinical manifestations, pathology report, surgical methods, types of adjuvant treatment modalities, type of recurrence, and follow-up period.

Results

There were 1944 cases (20.1%) of recurrence. Median age at the first recurrence was 49.5 years (range 21.8–92.9). Median follow-up was 28.8 months (range 0–228.0) from the time of relapse. Median survival time was 35.0 months. Survival after recurrence (SAR) significantly improved in 2003–2008 compared to that in 1993–2002. Median survival time increased from 27.6 months in the period I to 42.3 months in period II (p = 0.001). Independent prognostic factors after the first recurrence by multivariate analysis were age at diagnosis, tumor size, nodal status, tumor grade, subtype, anti-hormonal therapy, time at diagnosis, and disease-free interval.

Conclusions

Outcomes of breast cancer have been improving recently, and survival time after the first recurrence of breast cancer has steadily increased in recent decades. We confirmed that advances in treatments have contributed to this improvement in survival after the first recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Haffty BG, Fischer D, Beinfield M, McKhann C. Prognosis following local recurrence in the conservatively treated breast cancer patient. Int J Radiat Oncol Biol Phys. 1991;21:293–8.

    Article  CAS  PubMed  Google Scholar 

  2. Ravdin PM, Siminoff LA, Davis GJ, Mercer MB, Hewlett J, Gerson N, et al. Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol. 2001;19:980–91.

    Article  CAS  PubMed  Google Scholar 

  3. Michaelson JS, Chen LL, Bush D, Fong A, Smith B, Younger J. Improved web-based calculators for predicting breast carcinoma outcomes. Breast Cancer Res Treat. 2011;128:827–35. https://doi.org/10.1007/s10549-011-1366-9.

    Article  PubMed  Google Scholar 

  4. Tsuji W, Teramukai S, Ueno M, Toi M, Inamoto T. Prognostic factors for survival after first recurrence in breast cancer: a retrospective analysis of 252 recurrent cases at a single institution. Breast Cancer. 2014;21:86–95. https://doi.org/10.1007/s12282-012-0358-x.

    Article  PubMed  Google Scholar 

  5. Giordano SH, Buzdar AU, Smith TL, Kau SW, Yang Y, Hortobagyi GN. Is breast cancer survival improving? Cancer. 2004;100:44–52.

    Article  PubMed  Google Scholar 

  6. Chapman JA, Trudeau ME, Pritchard KI, Sawka CA, Mobbs BG, Hanna WM, et al. A comparison of all-subset Cox and accelerated failure time models with Cox step-wise regression for node-positive breast cancer. Breast Cancer Res Treat. 1992;22:263–72.

    Article  CAS  PubMed  Google Scholar 

  7. McCready DR, Chapman JA, Hanna WM, Kahn HJ, Murray D, Fish EB, et al. Factors affecting distant disease-free survival for primary invasive breast cancer: use of a log-normal survival model. Ann Surg Oncol. 2000;7:416–26.

    Article  CAS  PubMed  Google Scholar 

  8. Koenders PG, Beex LV, Kloppenborg PW, Smals AG, Benraad TJ. Human breast cancer: survival from first metastasis. Breast Cancer Study Group. Breast Cancer Res Treat. 1992;21:173–80.

    Article  CAS  PubMed  Google Scholar 

  9. Weichselbaum RR, Hellman S. Oligometastases revisited. Nat Rev Clin Oncol. 2011;8:378–82.

    Article  CAS  PubMed  Google Scholar 

  10. Thelen A, Benckert C, Jonas S, Lopez-Hanninen E, Sehouli J, Neumann U, et al. Liver resection for metastases from breast cancer. J Surg Oncol. 2008;97:25–9. https://doi.org/10.1002/jso.20911.

    Article  PubMed  Google Scholar 

  11. Clark GM, Sledge GW Jr, Osborne CK, McGuire WL. Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol. 1987;5:55–61. https://doi.org/10.1200/jco.1987.5.1.55.

    Article  PubMed  CAS  Google Scholar 

  12. Vogel CL, Azevedo S, Hilsenbeck S, East DR, Ayub J. Survival after first recurrence of breast cancer. The Miami experience. Cancer. 1992;70:129–35.

    Article  CAS  PubMed  Google Scholar 

  13. Korean Breast Cancer Society. Nationwide Korean breast cancer data of 2004 using breast cancer registration program. J Breast Cancer. 2006;9:151–61. https://doi.org/10.4048/jbc.2006.9.2.151.

    Article  Google Scholar 

  14. Jung YS, Na KY, Kim KS, Ahn SH, Lee SJ, Lee SJ, et al. Nation-wide Korean breast cancer data from 2008 using the breast cancer registration program. J Breast Cancer. 2011;14:229–36. https://doi.org/10.4048/jbc.2011.14.3.229.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Korean Breast Cancer Society. Nationwide Korean breast cancer data of 2002. J Korean Breast Cancer Soc. 2004;7:72–83.

    Article  Google Scholar 

  16. Ahn SH. Clinical characteristics of breast cancer patients in Korea in 2000. Arch Surg. 2004;139:27–30. discussion 1.

    Article  PubMed  Google Scholar 

  17. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. https://doi.org/10.3322/caac.20107.

    Article  PubMed  Google Scholar 

  18. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–1717. https://doi.org/10.1016/S0140-6736(05)66544-0.

    Article  CAS  Google Scholar 

  19. Valagussa P, Bonadonna G, Veronesi U. Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients. Cancer. 1978;41:1170–8.

    Article  CAS  PubMed  Google Scholar 

  20. Yamashita H, Iwase H, Toyama T, Takahashi S, Sugiura H, Yoshimoto N, et al. Estrogen receptor-positive breast cancer in Japanese women: trends in incidence, characteristics, and prognosis. Ann Oncol. 2011;22:1318–25. https://doi.org/10.1093/annonc/mdq596.

    Article  PubMed  CAS  Google Scholar 

  21. You JM, Kim YG, Moon HG, Nam SJ, Lee JW, Lim W, et al. Survival improvement in Korean breast cancer patients due to increases in early-stage cancers and hormone receptor positive/HER2 negative subtypes: a nationwide registry-based study. J Breast Cancer. 2015;18:8–15. https://doi.org/10.4048/jbc.2015.18.1.8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Powles TJ, Coombes RC, Smith IE, Jones JM, Ford HT, Gazet JC. Failure of chemotherapy to prolong survival in a group of patients with metastatic breast cancer. Lancet. 1980;1:580–2.

    Article  CAS  PubMed  Google Scholar 

  23. Bonadonna G, Valagussa P, Rossi A, Tancini G, Brambilla C, Zambetti M, et al. Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Res Treat. 1985;5:95–115.

    Article  CAS  PubMed  Google Scholar 

  24. Gentilini O, Botteri E, Veronesi P, Sangalli C, Del Castillo A, Ballardini B, et al. Repeating conservative surgery after ipsilateral breast tumor reappearance: criteria for selecting the best candidates. Ann Surg Oncol. 2012;19:3771–6. https://doi.org/10.1245/s10434-012-2404-5.

    Article  PubMed  Google Scholar 

  25. Botteri E, Rotmensz N, Sangalli C, Toesca A, Peradze N, De Oliveira Filho HR, et al. Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome. Ann Oncol. 2009;20:1008–12. https://doi.org/10.1093/annonc/mdn732.

    Article  PubMed  CAS  Google Scholar 

  26. Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378:771–84. https://doi.org/10.1016/s0140-6736(11)60993-8.

    Article  PubMed  CAS  Google Scholar 

  27. Peto R, Davies C, Godwin J, Gray R, Pan HC, Clarke M, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012;379:432–44. https://doi.org/10.1016/s0140-6736(11)61625-5.

    Article  PubMed  CAS  Google Scholar 

  28. Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, Martin M, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol. 2014;15:156–63. https://doi.org/10.1016/s1470-2045(13)70589-8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Bhoo-Pathy N, Verkooijen HM, Tan EY, Miao H, Taib NA, Brand JS, et al. Trends in presentation, management and survival of patients with de novo metastatic breast cancer in a Southeast Asian setting. Sci Rep. 2015;5:16252. https://doi.org/10.1038/srep16252.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Di Meglio A, Freedman RA, Lin NU, Barry WT, Metzger-Filho O, Keating NL, et al. Time trends in incidence rates and survival of newly diagnosed stage IV breast cancer by tumor histology: a population-based analysis. Breast Cancer Res Treat. 2016;157:587–96. https://doi.org/10.1007/s10549-016-3845-5.

    Article  PubMed  Google Scholar 

  31. Inoue K, Ogawa M, Horikoshi N, Aiba K, Mukaiyama T, Mizunuma N, et al. Evaluation of prognostic factors for 233 patients with recurrent advanced breast cancer. Jpn J Clin Oncol. 1991;21:334–9.

    PubMed  CAS  Google Scholar 

  32. Paterson AH, Zuck VP, Szafran O, Lees AW, Hanson J. Influence and significance of certain prognostic factors on survival in breast cancer. Eur J Cancer Clin Oncol. 1982;18:937–43.

    Article  CAS  PubMed  Google Scholar 

  33. Chang J, Clark GM, Allred DC, Mohsin S, Chamness G, Elledge RM. Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor. Cancer. 2003;97:545–53. https://doi.org/10.1002/cncr.11083.

    Article  PubMed  Google Scholar 

  34. Howell A, Barnes DM, Harland RN, Redford J, Bramwell VH, Wilkinson MJ, et al. Steroid-hormone receptors and survival after first relapse in breast cancer. Lancet. 1984;1:588–91.

    Article  CAS  PubMed  Google Scholar 

  35. Pater JL, Mores D, Loeb M. Survival after recurrence of breast cancer. Can Med Assoc J. 1981;124:1591–5.

    PubMed  PubMed Central  CAS  Google Scholar 

  36. Insa A, Lluch A, Prosper F, Marugan I, Martinez-Agullo A, Garcia-Conde J. Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat. 1999;56:67–78.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant (2012-510, 2013-510) from Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. The authors thank all clinical surgeons for collecting data. SB Lee and SH Ahn substantially contributed to the conception and design of the study, and to the analysis and interpretation of the data; SB Lee drafted the paper, and all authors revised the paper for intellectual content and approved the final version of the paper.

Author information

Authors and Affiliations

  1. Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea

    Sae Byul Lee, Guiyun Sohn, Jisun Kim, Il Yong Chung, Jong Won Lee, Hee Jeong Kim, Beom Seok Ko, Byung Ho Son & Sei-Hyun Ahn

Authors
  1. Sae Byul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guiyun Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jisun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Il Yong Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jong Won Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hee Jeong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beom Seok Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Byung Ho Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sei-Hyun Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sei-Hyun Ahn.

Ethics declarations

Conflict of interest

The authors do not have any conflicts of interests to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 184 KB)

Supplementary material 2 (TIFF 184 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.B., Sohn, G., Kim, J. et al. Survival analysis according to period and analysis of the factors influencing changes in survival in patients with recurrent breast cancer: a large-scale, single-center study. Breast Cancer 25, 639–649 (2018). https://doi.org/10.1007/s12282-018-0869-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-018-0869-1

Keywords

Search

Navigation