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Twenty-year risks of breast cancer-specific mortality for stage III breast cancer in the surveillance, epidemiology, and end results registry

Breast Cancer Research and Treatment volume 187, pages 843–852 (2021)Cite this article

Abstract

Purpose

We aimed to report the 20-year risk of breast cancer-specific mortality (BCSM), report the risk of BCSM conditional on having survived 5 years, and identify factors associated with late deaths in stage III breast cancer.

Methods

Using Surveillance, Epidemiology, and End Results data, we included women with stage III breast cancer diagnosed from 1990 to 2005. We excluded women with unknown hormone receptor (HR) status, women who did not undergo resection of the primary tumor or axillary nodes, or unknown cause of death. We estimated risks of BCSM using cumulative incidence function and used Fine and Gray regression to identify factors associated with late deaths.

Results

Final sample was 36,500 patients with 14 years of median follow-up. For each stage subgroup, the risk of BCSM at 20 years was significantly higher for HR-negative vs HR-positive tumors (IIIA: 49.8% vs 43.2%, P < 0.0001; IIIB: 60.9% vs 47.6%, P < 0.0001; IIIC: 68.7% vs 63.1%, P < 0.0001). Compared with the risks of non-BCSM, the risks of BCSM at 20 years were four times higher in stage IIIC HR-positive disease and seven times higher in stage IIIC HR-negative disease. Risks of BCSM conditional on having survived 5 years depended on tumor size, nodal status, race, and tumor grade for HR-positive disease and depended on tumor size, nodal status, and age for HR-negative disease.

Conclusions

In stage III breast cancer, the risk of BCSM at 20 years is very high and remains important even beyond the first 5 years in both HR-positive and HR-negative disease. Late BCSM depends on traditional clinicopathologic factors.

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Availability of data and materials

The datasets analyzed during the current study are available from the SEER registry https://seer.cancer.gov/.

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Acknowledgements

These data were presented in part at the 2019 San Antonio Breast Cancer Symposium (December 10-14, 2019): abstract P5-06-13.

Funding

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Authors and Affiliations

  1. Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    José P. Leone, Nabihah Tayob, Michael J. Hassett, Rachel A. Freedman, Sara M. Tolaney, Eric P. Winer & Nancy U. Lin

  2. Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina

    Bernardo A. Leone, Julieta Leone & Carlos T. Vallejo

Authors
  1. José P. Leone
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  2. Bernardo A. Leone
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  4. Michael J. Hassett
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  5. Julieta Leone
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  6. Rachel A. Freedman
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  7. Sara M. Tolaney
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  8. Eric P. Winer
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Contributions

JPL: Conceptualization, Data curation, Formal analysis, and Writing—original draft; BAL: Conceptualization and Writing—review and editing; NT: Data curation, Formal analysis, Methodology, and Writing—review and editing; MJH: Methodology and Writing—review and editing; JL: Methodology and Writing—review and editing; RAF: Conceptualization and Writing—review and editing; SMT: Methodology and Writing—review and editing; EPW: Conceptualization, Supervision, and Writing—review and editing; CTV: Conceptualization, Supervision, and Writing—review and editing; NUL: Conceptualization, Supervision, and Writing—review and editing.

Corresponding author

Correspondence to José P. Leone.

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Conflict of interest

JPL received research funding from Kazia Therapeutics and Merck. MJH received research support from the National Institute of Health, American Cancer Society, Brown Performance Group, and IBM. RAF has institutional research funding from Puma Biotechnology. SMT receives institutional research funding from Novartis, Genentech, Eli Lilly, Pfizer, Merck, Exelixis, Eisai, Bristol Meyers Squibb, AstraZeneca, Cyclacel, Immunomedics, Odonate, Sanofi, and Nektar. SMT has served as an advisor/consultant to Novartis, Eli Lilly, Pfizer, Merck, AstraZeneca, Eisai, Puma, Genentech, Immunomedics, Nektar, Paxman, Athenex, Oncopep, Daiichi-Sankyo, G1 Therapeutics, Silverback Therapeutics, Kyowa Kirin Pharmaceuticals, AbbVie, Sanofi, Seattle Genetics, Celldex, Bristol-Myers Squibb, and Nanostring. EPW consultant honoraria from Carrick Therapeutics, G1 Therapeutics, Genentech/Roche, Genomic Health, GSK, Jounce, Leap, Lilly, Novartis, Seattle Genetics, and Syros; scientific advisory board for Leap; and institutional research support from Genentech/Roche. NUL receives institutional research funding from Genentech, Merck, Seattle Genetics, and Pfizer and has served as an advisor/consultant to Seattle Genetics, AstraZeneca, Daiichi-Sankyo, Denali Therapeutics, and the California Institute for Regenerative Medicine. All other authors have declared no conflicts of interest.

Ethics approval

Given that only deidentified data were used for this study, the study was considered exempt from Dana-Farber Cancer Institute’s Office for Human Research Studies.

Research involving human participants and/or animals

Given that only deidentified data were used for this study, the study was considered exempt from Dana-Farber Cancer Institute’s Office for Human Research Studies.

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Leone, J.P., Leone, B.A., Tayob, N. et al. Twenty-year risks of breast cancer-specific mortality for stage III breast cancer in the surveillance, epidemiology, and end results registry. Breast Cancer Res Treat 187, 843–852 (2021). https://doi.org/10.1007/s10549-021-06121-x

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  • DOI: https://doi.org/10.1007/s10549-021-06121-x

Keywords

  • Hormone receptor
  • Estrogen receptor
  • Prognostic factors
  • Late
  • Recurrence
  • Relapse