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Prognosis in patients diagnosed with loco-regional failure of breast cancer: 34 years longitudinal data from the Stockholm–Gotland cancer registry

  • Epidemiology
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Abstract

Rationale

Survival after loco-regional failure (LRF) of breast cancer was investigated at the population level.

Methods

Using the Stockholm cancer registry, 2698 patients diagnosed with LRF between 1980 and 2014 were identified and divided into three cohorts by year of LRF diagnosis. Post-relapse event-free survival (EFS) and overall survival (OS) were analyzed separately in local and loco-regional relapses and compared across the cohorts by Kaplan–Meier method. Relative survival was estimated and Poisson regression models, adjusted for clinically relevant prognostic factors, were fitted for excess mortality ratio calculation. Age-related survival trends were also explored.

Results

Among 1922 patients diagnosed with local relapse, 1032 (54%) EFS events and 931 (48%) deaths were registered. A significant improvement in EFS (p < 0.001) and OS (p < 0.001) was demonstrated in tumors that recurred locally in the years 1990–1999 and 2000–2014 compared with 1980–1989, regardless of age at relapse (≤ 60 years; > 60 years). In women with loco-regional relapse, 557 out of 776 (72%) experienced a post-relapse event and 522 (67%) died. Significantly longer EFS and OS were seen over time in the whole group (p < 0.001 and p = 0.003, respectively) and in younger (p < 0.001; p < 0.001) but not in older women (p = 0.55; p = 0.80). Relative survival was consistent with OS and a statistically significant decrease in mortality after loco-regional recurrence over time was seen only in women aged ≤ 60 years.

Conclusions

Survival after loco-regional failure of breast cancer has improved over time, especially in younger women.

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References

  1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241. https://doi.org/10.1056/NEJMoa022152

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232. https://doi.org/10.1056/NEJMoa020989

    Article  PubMed  Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative G, Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378 (9804):1707–1716. https://doi.org/10.1016/S0140-6736(11)61629-2

    Article  Google Scholar 

  4. Early Breast Cancer Trialists’ Collaborative G (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717. https://doi.org/10.1016/S0140-6736(05)66544-0

    Article  CAS  Google Scholar 

  5. Albain K, Anderson S, Arriagada R, Barlow W, Bergh J, Bliss J, Buyse M, Cameron D, Carrasco E, Clarke M, Correa C, Coates A, Collins R, Costantino J, Cutter D, Cuzick J, Darby S, Davidson N, Davies C, Davies K, Delmestri A, Di Leo A, Dowsett M, Elphinstone P, Evans V, Ewertz M, Gelber R, Gettins L, Geyer C, Goldhirsch A, Godwin J, Gray R, Gregory C, Hayes D, Hill C, Ingle J, Jakesz R, James S, Kaufmann M, Kerr A, MacKinnon E, McGale P, McHugh T, Norton L, Ohashi Y, Paik S, Pan HC, Perez E, Peto R, Piccart M, Pierce L, Pritchard K, Pruneri G, Raina V, Ravdin P, Robertson J, Rutgers E, Shao YF, Swain S, Taylor C, Valagussa P, Viale G, Whelan T, Winer E, Wang Y, Wood W, Ebctcg (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. Lancet 379(9814):432–444. https://doi.org/10.1016/S0140-6736(11)61625-5

    Article  CAS  PubMed  Google Scholar 

  6. Early Breast Cancer Trialists’ Collaborative G, Dowsett M, Forbes JF, Bradley R, Ingle J, Aihara T, Bliss J, Boccardo F, Coates A, Coombes RC, Cuzick J, Dubsky P, Gnant M, Kaufmann M, Kilburn L, Perrone F, Rea D, Thurlimann B, van de Velde C, Pan H, Peto R, Davies C, Gray R (2015) Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet 386 (10001):1341–1352. https://doi.org/10.1016/S0140-6736(15)61074-1

    Article  CAS  Google Scholar 

  7. Dowsett M, Cuzick J, Ingle J, Coates A, Forbes J, Bliss J, Buyse M, Baum M, Buzdar A, Colleoni M, Coombes C, Snowdon C, Gnant M, Jakesz R, Kaufmann M, Boccardo F, Godwin J, Davies C, Peto R (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28(3):509–518. https://doi.org/10.1200/JCO.2009.23.1274

    Article  CAS  PubMed  Google Scholar 

  8. Moja L, Tagliabue L, Balduzzi S, Parmelli E, Pistotti V, Guarneri V, D’Amico R (2012) Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev (4):CD006243. https://doi.org/10.1002/14651858.CD006243.pub2

  9. Howlader NNA, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/. Based on November 2016 SEER data submission, posted to the SEER web site, April 2017

  10. Mauri D, Pavlidis N, Ioannidis JP (2005) Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 97(3):188–194. https://doi.org/10.1093/jnci/dji021

    Article  PubMed  Google Scholar 

  11. van Laar C, van der Sangen MJ, Poortmans PM, Nieuwenhuijzen GA, Roukema JA, Roumen RM, Tjan-Heijnen VC, Voogd AC (2013) Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. Eur J Cancer 49(15):3093–3101. https://doi.org/10.1016/j.ejca.2013.05.030

    Article  PubMed  Google Scholar 

  12. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, Fisher B, Wolmark N (2006) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 24(13):2028–2037. https://doi.org/10.1200/JCO.2005.04.3273

    Article  PubMed  Google Scholar 

  13. Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, Geyer CE Jr, Wickerham DL, Costantino JP, Wolmark N (2009) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol 27(15):2466–2473. https://doi.org/10.1200/JCO.2008.19.8424

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wapnir IL, Aebi S, Geyer CE, Zahrieh D, Gelber RD, Anderson SJ, Robidoux A, Bernhard J, Maibach R, Castiglione-Gertsch M, Coates AS, Piccart MJ, Clemons MJ, Costantino JP, Wolmark N, Ibcsg, Big, Nsabp (2008) A randomized clinical trial of adjuvant chemotherapy for radically resected locoregional relapse of breast cancer: IBCSG 27-02, BIG 1-02, and NSABP B-37. Clin Breast Cancer 8(3):287–292. https://doi.org/10.3816/CBC.2008.n.035

    Article  PubMed  Google Scholar 

  15. Wapnir IPKN, Anderson SJ, Robidoux A, Martin M, Nortier JWR, Paterson AHG, Rimawi MF, Lang I, Baena Cañada JM, Thurlimann BJK, Mamounas EP, Geyer CE, Gelber SI, Coates AC, Gelber SI, Rastogi P, Regan MM, Wolmark N, Aebi SP (2017) Chemotherapy (CT) for isolated locoregional recurrence (ILRR) of breast cancer in ER-positive (ER+) and ER-negative (ER−) cohorts: final analysis of the CALOR trial. DOI: 101200/JCO20173515_suppl513. J Clin Oncol 35:513–513

    Article  Google Scholar 

  16. Waeber M, Castiglione-Gertsch M, Dietrich D, Thurlimann B, Goldhirsch A, Brunner KW, Borner MM, Swiss Group for Clinical Cancer R (2003) Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation. Ann Oncol 14(8):1215–1221

    Article  CAS  Google Scholar 

  17. Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E, Group EGW (2012) Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii11-19. https://doi.org/10.1093/annonc/mds232

    Article  Google Scholar 

  18. Mattsson B, Rutqvist LE, Wallgren A (1985) Undernotification of diagnosed cancer cases to the Stockholm Cancer Registry. Int J Epidemiol 14(1):64–69

    Article  CAS  Google Scholar 

  19. Emilsson L, Lindahl B, Koster M, Lambe M, Ludvigsson JF (2015) Review of 103 Swedish Healthcare Quality Registries. J Intern Med 277(1):94–136. https://doi.org/10.1111/joim.12303

    Article  CAS  PubMed  Google Scholar 

  20. Hirsch AKL, Dizon Management of locoregional recurrence of breast cancer after breast conserving therapy. https://www.uptodatecom

  21. Hirsch AKL, Sabel MS, Hayes DF Management of locoregional recurrence of breast cancer after mastectomy. https://www.uptodatecom

  22. Kaplan EL, MP (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53(282):457–481

    Article  Google Scholar 

  23. Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50(3):163–170

    CAS  PubMed  Google Scholar 

  24. Cox DR (1972) Regression models and life-tables. J Royal Stat Soc Series B (Methodological) 34(2):187(220)

    Google Scholar 

  25. Ederer F, Axtell LM, Cutler SJ (1961) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121

    CAS  PubMed  Google Scholar 

  26. Dickman PW, Sloggett A, Hills M, Hakulinen T (2004) Regression models for relative survival. Stat Med 23(1):51–64. https://doi.org/10.1002/sim.1597

    Article  PubMed  Google Scholar 

  27. Editors PMO (2014) Studies: getting clear about transparency. PLoS Med 11(8):e1001711

    Article  Google Scholar 

  28. IBM Corp. Released 2013. IBM SPSS Statistics for Macintosh, Version 22.0. Armonk. IBM Corp, New York

  29. https://cran.rproject.org/web/packages/relsurv/relsurv.pdf

  30. Dickman PW CE (2015) Estimating and modeling relative survival. Stata J 15:186–215 Number 1

    Google Scholar 

  31. Schmoor C, Sauerbrei W, Bastert G, Schumacher M (2000) Role of isolated locoregional recurrence of breast cancer: results of four prospective studies. J Clin Oncol 18(8):1696–1708. https://doi.org/10.1200/JCO.2000.18.8.1696

    Article  CAS  PubMed  Google Scholar 

  32. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ, Cancer I, Surveillance Modeling Network C (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353(17):1784–1792. https://doi.org/10.1056/NEJMoa050518

    Article  CAS  PubMed  Google Scholar 

  33. Engholm GFJ, Christensen N, Kejs AMT, Hertzum-Larsen R, Johannesen TB, Khan S, Leinonen MK, Ólafsdóttir E, Petersen T, Schmidt LKH, Trykker H, Storm HH. NORDCAN: Cancer Incidence, mortality, prevalence and survival in the Nordic Countries. Version 73 (08072016) Association of the Nordic Cancer Registries Danish Cancer Society. http://www.ancrnu. Accessed 25 Oct 2017

  34. Smith IE (2002) New drugs for breast cancer. Lancet 360(9335):790–792. https://doi.org/10.1016/S0140-6736(02)09903-8

    Article  PubMed  Google Scholar 

  35. Foukakis T, Fornander T, Lekberg T, Hellborg H, Adolfsson J, Bergh J (2011) Age-specific trends of survival in metastatic breast cancer: 26 years longitudinal data from a population-based cancer registry in Stockholm, Sweden. Breast Cancer Res Treat 130(2):553–560. https://doi.org/10.1007/s10549-011-1594-z

    Article  PubMed  Google Scholar 

  36. Eaker S, Dickman PW, Bergkvist L, Holmberg L, Uppsala/Orebro Breast Cancer G (2006) Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden. PLoS Med 3(3):e25. https://doi.org/10.1371/journal.pmed.0030025

    Article  PubMed  PubMed Central  Google Scholar 

  37. Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, Martin M, Nortier JW, Paterson AH, Rimawi MF, Canada JM, Thurlimann B, Murray E, Mamounas EP, Geyer CE Jr, Price KN, Coates AS, Gelber RD, Rastogi P, Wolmark N, Wapnir IL, investigators C (2014) Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol 15(2):156–163. https://doi.org/10.1016/S1470-2045(13)70589-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The study was supported by the Swedish Cancer Society (CAN 2015/713), the Cancer Society in Stockholm (154132), Breast Cancer Theme Center (BRECT) at Karolinska Institutet, and the Stockholm County Council.

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Authors and Affiliations

  1. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Claudette Falato, Axel Nordblom, Anastasios Sofiadis, Johan Hartman, Jonas Bergh & Theodoros Foukakis

  2. Department of Medical Oncology, British Columbia Cancer Agency, Kelowna, BC, Canada

    Sara K. Taylor

  3. Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden and Scandinavian Development Services, Danderyd, Sweden

    Robert Szulkin

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Louise Eriksson

  5. Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden

    Irma Fredriksson

  6. Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden

    Jonas Bergh & Theodoros Foukakis

  7. Department of Oncology and Pathology, Karolinska University Hospital, CCK, R8:03, 17176, Stockholm, Sweden

    Claudette Falato

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  1. Claudette Falato
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Correspondence to Claudette Falato.

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The authors declare that they have no competing interests.

Ethical approval

The analysis in this study was approved by the Research Ethics Committee at Karolinska Institutet (Stockholm, Sweden) and complies with the current laws in Sweden.

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10549_2018_4936_MOESM1_ESM.pdf

Supplementary Figure 1 Relative survival (RS) estimates for a) the overall population diagnosed with locally relapsed breast cancer, b) for patients ≤ 60 years diagnosed with local relapse of breast cancer, c) for patients > 60 years diagnosed with local relapse of breast cancer, d) the overall population diagnosed with loco-regionally relapsed breast cancer, e) for patients ≤ 60 years diagnosed with loco-regional relapse of breast cancer, f) for patients > 60 years diagnosed with loco-regional relapse of breast cancer (PDF 997 KB)

10549_2018_4936_MOESM2_ESM.pdf

Supplementary Figure 2 Relative survival (RS) estimates restricted to the years between 2000 and 2014 for a) the overall population diagnosed with local relapse of breast cancer, b) for patients ≤ 60 years diagnosed with local relapse of breast cancer, c) for patients > 60 years diagnosed with local relapse of breast cancer, d) the overall population diagnosed with loco-regional relapse of breast cancer, e) for patients ≤ 60 years diagnosed with loco-regional relapse of breast cancer, f) for patients > 60 years diagnosed with loco-regional relapse of breast cancer (PDF 778 KB)

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Falato, C., Taylor, S.K., Szulkin, R. et al. Prognosis in patients diagnosed with loco-regional failure of breast cancer: 34 years longitudinal data from the Stockholm–Gotland cancer registry. Breast Cancer Res Treat 172, 703–712 (2018). https://doi.org/10.1007/s10549-018-4936-2

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