Introduction: Historically, young breast cancer patients proved to have a poorer prognosis regarding survival and locoregional recurrence. Over the last two decades, the survival of breast cancer patients has improved substantially, while at the same time locoregional recurrence rates decreased. The diminishing recurrence rates in the overall breast cancer population and acknowledgement of tumor biology and intrinsic subtypes in relation to age, raise the question whether the historically high locoregional recurrence risk in young women has decreased over a time where systemic treatment has evolved, particularly for the aggressive tumor types that occur frequently in young women. The aim of this study was to evaluate contemporary local and regional recurrence rates in very young breast cancer patients in relation to tumor biology in the shape of intrinsic subtypes. Methods: Women <35 years of age who were operated for primary unilateral invasive breast cancer between 2003-2008 were selected from the Netherlands Cancer Registry. Patients were categorized according to intrinsic subtypes using hormone receptor and HER2 status. The 5-year risks of developing local recurrence (LR) and regional lymph node recurrence (RR) were estimated using Kaplan Meier statistics. The prognostic influence of different clinicopathological and treatment factors was assessed. Results: A total of 1,000 patients were identified. The overall 5-year LR and RR rates were 3.5% and 3.7% respectively and a decreasing trend for both rates was observed over time. Overall 5-year local, regional and distant recurrence rates over time in breast cancer patients <35 years (n=1,000) Local recurrence*Regional recurrenceDistant metastases NRateNRateNRate2003n=21384.2%116.1%3617.8%2004n=212105.6%105.1%3819.2%2005n=18232.0%53.1%2514.6%2006n=17053.2%21.2%138.2%2007•n=11722.1%10.9%98.1%2008•n=10633.2%44.4%1010.0%Totaln=1,000313.5%333.7%13113.9%*Local recurrence (ipsilateral in-breast recurrence + new primary) •Fewer patients were included in the years 2007-2008 compared to earlier years due to the fact that some hospitals did not provide data for those years. Rates represent Kaplan Meier estimates Intrinsic subtype proved to be a prognostic factor for both LR and RR (P=0.0556 and P=0.0141, respectively). Particularly HR-/HER2+ tumors were associated with high LR and RR rates. Patients with lymph node metastases at time of diagnosis had a higher RR-risk in both the total population (P=0.0349) as well as within the different intrinsic subtypes, although only significantly in the triple negative group (P=0.0401). Type of surgery did not influence the rate of LR and RR in this study. Conclusions: Overall, the LR and RR rates in very young breast cancer patients were relatively low and decreased over time. The higher recurrence rates in this population were associated with the presence of more aggressive intrinsic subtypes. We emphasize that tumor biology should guide decision-making towards optimal treatment in this specific population. Although longer follow-up is needed, especially for this very young patient population, the results of this study provide important insight in the locoregional recurrence risks for this historically high-risk population. Citation Format: Aalders KC, Postma EL, Strobbe LJ, van der Heiden-van der Loo M, Sonke GS, Boersma LJ, van Diest PJ, Siesling S, van Dalen T. Contemporary local and regional recurrence rates in very young breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-01.
Background Survival estimates valid at the time of diagnosis are of limited value for (ex-)breast cancer patients who survived several years, as it includes information on already deceased patients. This study analyzed the 10-year conditional risk of recurrent breast cancer in specific prognostic subgroups according to T and N stage and breast cancer subtypes. Secondly, we investigated 10-year conditional overall (OS) and relative survival (RS), adjusted for confounding. Patients and methods We selected all women diagnosed in 2005 with operated T1-2N0-1 breast cancer from the Netherlands Cancer Registry. Patients were classified into T1N0, T1N1, T2N0 and T2N1 stage. Ten-year conditional recurrence rates were calculated for every year from diagnosis for patients without an event (local (LR), regional recurrence (RR), distant metastasis (DM) or death). Ten-year conditional OS was calculated using multivariable Cox regression. RS was estimated by dividing patient survival rates by those of the general Dutch population. Results We included 7,969 patients: 52.3% had T1N0, 15.3% T1N1, 19.9% T2N0 and 12.5% T2N1 stage. For T1N0, 10-year LR rates changed from 4.6% at diagnosis to 0.5% in year 10. RR rates decreased from 2.3% to 0.2% and DM rates decreased from 7.8% to 0.6%. For T2N1 stage, the LR, RR and DM rates decreased from 6.2% to 0.8%, 5.2% to 0.4% and 19.6% to 1.5%, respectively. Of all patients, 1,702 patients (21.4%) had an unknown breast cancer subtype and were consequently excluded from the analyses according to subtype. Of the remaining 6,267 patients, 3,774 (60.2%) had luminal A, 1,465 (23.4%) had luminal B, 314 (5.0%) had HER2 positive and 714 (11.4%) had triple negative disease For the luminal A subtype, LR, RR and DM rates ranged from 3.9% to 0.4%, 1.7% to 0.5% and 7.3% to 1.1%, while for triple negative these rates ranged between 5.6% to 0.7%, 4.9% to 0.2% and 16.7% to 0%, respectively. Differences between subgroups attenuated over time and all recurrence rates became ≤1.5% in year 10. Ten-year OS and RS, adjusted for confounding, showed diminishing risk differences between subgroups over time. Conclusion Differences in recurrence rates, OS and RS between prognostic subgroups decreased as years passed by. These results highlight the importance of taking into account disease-free years to more accurately predict (ex-)breast cancer patients' prognosis over time. Citation Format: van Maaren MC, Strobbe LJ, Smidt ML, Moossdorff M, Poortmans PM, Siesling S. 10-year conditional recurrence risks, overall and relative survival for breast cancer patients in the Netherlands: Taking account of event-free years [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-19.
Background Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN). At present, therefore, various hospitals use different SN pathology protocols, leading to different SN findings and subsequent surgical treatment strategies. Previously, we reported in a prospective registry study of 4 hospitals in the Netherlands, that ultra-staging led to more axillary lymph node dissections (ALND) (Bolster et al. Ann Surg Oncol 2006). This present study reports follow-up data of the patients who had a negative SN, so patients who did not undergo an additional ALND. The question was, whether ultra-staging and thus fewer patients not undergoing an additional ALND, is effective in that it reduces the risk of relapse. Patients and Methods Patients from 4 hospitals (A, B, C, and D) were prospectively registered when they underwent a SN biopsy because of a cytological or histological proven invasive breast cancer. In hospitals A, B, and C, 3 levels of the SN were examined pathologically, whereas in hospital D at least 7 additional levels were examined. In the absence of apparent metastases with H&E examination, immunohistochemical examination was performed in all 4 hospitals. Patients with a positive SN, including isolated tumor cells, underwent an ALND. This analysis focuses on the SN negative patients, who did not undergo a completion ALND. In all cases a follow-up period of at least 5 years was guaranteed. Primary endpoint was 5-year regional recurrence rate. Results Of 541 patients who underwent a SN procedure, 341 (63%) patients had a negative SN, and did not undergo an ALND. In hospital D fewer patients had a negative SN when compared to patients in hospitals A, B, and C (34% versus 71%, P<0.001). At 5 years follow-up, 9 (2.6%) patients showed a regional lymph node relapse. Five (1.5%) patients had an axillary lymph node recurrence and 4 (1.2%) patients a supraclavicular recurrence. In hospital D none of the patients had a regional recurrence, as compared to 9 (2.9%) cases of recurrence in hospitals A, B, and C. Conclusion We showed that patients who underwent a less intensified SN pathology protocol, with a reduced performance of ALND, had a slightly increased risk of recurrence. However, whether this justifies 37 additional lymph node dissections per every 100 patients can be questioned. Therefore, a SN pathology protocol as is used in most centers nowadays, with on average 3 levels per node, seems to be adequate. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-31.
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