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Survival of de novo stage IV breast cancer patients over three decades

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Background

De novo stage IV breast cancer patients (BCIV) depict a clinical picture not influenced by adjuvant therapy. Therefore, the time-dependent impact of changes in diagnostics and treatments on progression and survival can best be evaluated in this subgroup.

Methods

BCIV patients from 1978 to 2013 registered in the Munich Cancer Registry were divided into four periods, and the trends were analysed. Survival was estimated by Kaplan–Meier methods, and prognostic factors were fitted with Cox proportional hazard models.

Results

Between 1978 and 2013, 88,759 patients were diagnosed with 92,807 cases of invasive and non-invasive BC. Of these patients, 4756 patients had distant metastases (MET) at diagnosis. The 5-year survival rate improved from 17.4 to 24.7%, while the pattern of metastases did not change. Improved staging diagnostics, a screening programme and primary systemic therapy changed the composition of prognostic strata. Patients with a similar composition as the 1978–1987 cohort exhibited a median survival difference of 13 months; however, neither univariate nor multivariate analysis showed a survival effect for the four periods as a surrogate indicator for changing treatments. HER2+ patients have with 27.6 months a slightly longer survival than all other BCIV patients.

Conclusions

Survival of de novo BCIV has only modestly improved since the late 1970s, partially masked by changing distributions of prognostic factors due to changes in diagnostics.

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Abbreviations

BCIV :

Breast cancer patient with de novo stage IV disease

HR:

Hormone receptor

(m)OS:

(Median) overall survival

MET:

Metastasization, metastases

1/≥2 MET :

1 or ≥2 MET organs involved

RCT:

Randomized controlled trial

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Acknowledgements

Many cooperating doctors and clinicians within the Munich Cancer Registry (MCR) deserve our special thanks. Close collaboration within the interdisciplinary network that is responsible for the care of patients produced the described data. We especially thank our co-workers within the MCR who handle hundreds of thousands of findings and treatment reports and compiled them into valid information regarding course of disease. Funding body: The Munich Cancer Registry (MCR) is part of the Munich Tumour Centre (TZM), the Institute of Medical Informatics, Biometry and Epidemiology (IBE), the Ludwig-Maximilians-Universität (LMU) and the University Hospital of Munich.

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Authors and Affiliations

  1. Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany

    Dieter Hölzel, Renate Eckel & Jutta Engel

  2. Head of the Breast Cancer Project Group of the Munich Tumour Centre (TZM) and of Department of Obstetrics and Gynaecology, Klinikum Landshut, Landshut, Germany

    Ingo Bauerfeind

  3. Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany

    Bernd Baier & Johann de Waal

  4. Department of Obstetrics and Gynaecology, Klinikum Rosenheim, Rosenheim, Germany

    Thomas Beck

  5. Department of Gynaecology, Rotkreuzklinikum, Munich, Germany

    Michael Braun & Ulrich Hamann

  6. Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany

    Johannes Ettl & Marion Kiechle

  7. Breast Center, Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany

    Nadia Harbeck

  8. Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany

    Sven Mahner

  9. Department of Obstetrics and Gynaecology, Klinikum Traunstein, Traunstein, Germany

    Christian Schindlbeck

Authors
  1. Dieter Hölzel
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  2. Renate Eckel
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  3. Ingo Bauerfeind
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  4. Bernd Baier
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  7. Johannes Ettl
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  8. Ulrich Hamann
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  9. Nadia Harbeck
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  10. Marion Kiechle
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  11. Sven Mahner
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  12. Christian Schindlbeck
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  13. Johann de Waal
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  14. Jutta Engel
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Corresponding author

Correspondence to Jutta Engel.

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The authors declare that they have no conflict of interest.

Ethical approval

Human rights: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Welfare of animals: This article does not contain any studies with animals performed by one of the authors.

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Hölzel, D., Eckel, R., Bauerfeind, I. et al. Survival of de novo stage IV breast cancer patients over three decades. J Cancer Res Clin Oncol 143, 509–519 (2017). https://doi.org/10.1007/s00432-016-2306-1

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  • DOI: https://doi.org/10.1007/s00432-016-2306-1

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