Is breast cancer survival improving?

Giordano, Sharon H.; Buzdar, Aman U.; Smith, Terry L.; Kau, Shu Wan; Yang, Ying; Hortobágyi, Gabriel N.

doi:10.1002/cncr.11859

Cited by 481 publications

(288 citation statements)

References 18 publications

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“…More advanced stages of breast neoplasm are related to shorter DFS and overall survival. 11,[27][28][29] A survey of women with stage III breast cancer subject to the same kind of treatment showed a difference in DFS at 5 years between stage IIIA (84%) and IIIB (33%) patients. 30 In a study that compiled data from the EUROCARE and SEER trials, the risk of death was shown to increase alongside staging (T2-3N0M0: risk of 4.87; T1-3NM0: risk of 10.44; T4M0: risk of 17.22; all in relation to T1N0M0).…”

Section: Discussionmentioning

confidence: 99%

Disease-free survival in patients with non-metastatic breast cancer

Diniz

Guerra

Cintra

et al. 2016

Rev. Assoc. Med. Bras.

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Introduction: Breast cancer is the second most common malignancy in the world and the one with highest incidence in the female population; it is also a major cause of death from cancer among women. Objective: To analyze the disease-free survival (DFS) at 5 years and prognostic factors in women with non-metastatic invasive breast cancer treated at a referral center for cancer care located in a medium-sized city in the Southeast of Brazil. Method: Patients diagnosed with the disease between 2003 and 2005 and identified through the institution's cancer hospital records were analyzed. The follow--up of cases was carried out through hospital records, and complemented by search in the database of the Mortality Information System (SIM) as well as telephone contact. The variables analyzed were distributed in the following blocks: socio-demographic data, tumor-related characteristics, and treatment-related characteristics. Survival functions were calculated using the Kaplan-Meier method and the prognostic factors were analyzed based on Cox proportional hazard model. Results:The study showed a DFS at 5 years of 72% (95CI 67.6-75.9). The main variables independently associated with DFS were lymph node involvement, use of hormone therapy, and education level. Conclusion: This study reinforces the importance of early diagnosis for DFS, pointing to the role of social aspects in this regard. The relevance of this research in the country is also highlighted, given the scarcity of studies on DFS in the Brazilian population.

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Section: Discussionmentioning

confidence: 99%

Disease-free survival in patients with non-metastatic breast cancer

Diniz

Guerra

Cintra

et al. 2016

Rev. Assoc. Med. Bras.

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“…Anderson Cancer Center within adjuvant anthracycline chemotherapy protocols, a significant survival improvement was associated with more recent period of recurrence [5]. Again, although the univariate analysis showed a Another study on patients from three French centers, did not address which intervention leads to survival improvement.…”

Section: Time From Progression To Deathmentioning

confidence: 96%

“…Trends in survival prolongation in MBC have been explored previously [4][5][6][7]. In a study examining the prognosis of 834 patients diagnosed with MBC from 1974 to 2000, longer survival, possibly attributed to the new active more recent therapies, was documented in the more recent cohorts [5].…”

Section: Introductionmentioning

confidence: 99%

“…In a study examining the prognosis of 834 patients diagnosed with MBC from 1974 to 2000, longer survival, possibly attributed to the new active more recent therapies, was documented in the more recent cohorts [5]. Data extracted from the Surveillance, Epidemiology and End Results registry (SEER), on 15,438 women with MBC diagnosed between 1988 and 2003 suggested a modest improvement in overall and breast-specific survival [4].…”

Section: Introductionmentioning

confidence: 99%

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Fifteen-year trends in metastatic breast cancer survival in Greece

Dafni

Grimani

Xyrafas

et al. 2009

Breast Cancer Res Treat

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In the metastatic setting, a detected time trend to improved prognosis could be attributed to the corresponding recent advances in the therapeutic approaches. The aim of the current study was to first assess, in a large cohort of well over a thousand patients, the time trends in survival in MBC for the last 15 years and second to explore its association to prognostic factors affecting outcome including therapeutic regimen. This meta-analysis uses individual patient data collected from all the trials on MBC (6 nonrandomized, 4 randomized) conducted by HeCOG from 1991 through 2006. Four 4-year time periods (1991-1994, 1995-1998, 1999-2002, and 2003-2006) were constructed for exploration of time trends in survival according to the patient's date of metastatic diagnosis. Different first line regimens in the 10 trials include anthracycline monotherapy (epirubicin, in the early 1990s) and taxanecontaining regimens either as monotherapy or in different combinations with anthracyclines or other drugs. In two phase II studies and in the last randomized study, trastuzumab was administered in all the patients with HER2 overexpressing tumors. In this study, information is based on a total of 1361 patients with a median follow up of 3.7 years and median survival of 1.9 years (median survival 1.28, 1.68, 2.20, and 2.57 years for 1991-1994, 1995-1998, 1999-2002, and 2003-2006, respectively). Survival improved significantly across diagnosis time periods, by 25, 44, and 51%, respectively, in each time period (1995)(1996)(1997)(1998) (1991)(1992)(1993)(1994). The effect of metastatic diagnosis time period remains almost unchanged in the presence of the following significant prognostic factors: performance status, hormonal receptor status, previous adjuvant chemotherapy, previous adjuvant hormonal treatment, visceral metastasis at entry, and number of metastatic sites. When exploring the effect of new systemic treatment introduction, taking into account the same significant prognostic factors, the effect of diagnosis time period disappears, and the survival improvement is explained directly by the introduction of new agents (hormonal treatment for metastatic disease: yes vs. no: HR = 0.72, P \ 0.001; taxanes at first line: yes vs. no: HR = 0.69, P = 0.002; trastuzumab at first line: yes vs. no: HR = 0.63, P \ 0.001). The results of this study provide significant evidence of improvement in prognosis of MBC patients within the last 15 years, taking into account all the important significant prognostic factors, and this improvement can be attributed to the use of new systemic treatment agents in the management of the disease.

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“…T he consistent association of large tumor size, rapid growth rate, and metastatic risk in a majority of cases of clinical cancer suggests that the molecular bases of these phenomena may be linked (1)(2)(3). However, the nature of this link remains unresolved.…”

mentioning

confidence: 99%

Lung metastasis genes couple breast tumor size and metastatic spread

Minn

Gupta

Padua

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

335

272

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The association between large tumor size and metastatic risk in a majority of clinical cancers has led to questions as to whether these observations are causally related or whether one is simply a marker for the other. This is partly due to an uncertainty about how metastasis-promoting gene expression changes can arise in primary tumors. We investigated this question through the analysis of a previously defined ''lung metastasis gene-expression signature'' (LMS) that mediates experimental breast cancer metastasis selectively to the lung and is expressed by primary human breast cancer with a high risk for developing lung metastasis. Experimentally, we demonstrate that the LMS promotes primary tumor growth that enriches for LMS ؉ cells, and it allows for intravasation after reaching a critical tumor size. Clinically, this corresponds to LMS ؉ tumors being larger at diagnosis compared with LMS ؊ tumors and to a marked rise in the incidence of metastasis after LMS ؉ tumors reach 2 cm. Patients with LMS-expressing primary tumors selectively fail in the lung compared with the bone or other visceral sites and have a worse overall survival. The mechanistic linkage between metastasis gene expression, accelerated tumor growth, and likelihood of metastatic recurrence provided by the LMS may help to explain observations of prognostic gene signatures in primary cancer and how tumor growth can both lead to metastasis and be a marker for cells destined to metastasize.cancer ͉ genomics ͉ oncogenesis T he consistent association of large tumor size, rapid growth rate, and metastatic risk in a majority of cases of clinical cancer suggests that the molecular bases of these phenomena may be linked (1-3). However, the nature of this link remains unresolved. Conventional models of metastasis envision rare metastatically competent variants emerging by chance as primary tumors grow, causally linking growth with likelihood of metastatic relapse (4, 5). In this view, genes that control primary tumor growth operate independently of stochastically acquired metastasis genes. Alternative models posit that prometastatic gene expression events are acquired early during tumorigenesis and may overlap with the genes that promote primary tumor growth, making tumor size a marker for metastatic risk (6). These alternative models form a teleological basis for using gene expression signatures from primary tumors to forecast whether patients are at high risk for micrometastatic disease. However, despite several reports on the success of gene signatures from primary tumors to predict development of distant spread (7-12), tumor size remains an independent prognostic factor on multivariate analysis (9). Thus, to what degree conventional versus alternative models can explain the acquisition of a metastatic phenotype remains unclear.One of the difficulties in addressing the fundamental question on how metastasis gene expression events are acquired relates to the genetically complex nature of the phenotype itself. It has long been believed that there are nume...

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Is breast cancer survival improving?

Abstract: For these cohorts of patients, the authors present data suggesting that the prognosis for patients with recurrent breast cancer improved between 1974 and 2000.

Cited by 481 publications

References 18 publications

Disease-free survival in patients with non-metastatic breast cancer

Disease-free survival in patients with non-metastatic breast cancer

Fifteen-year trends in metastatic breast cancer survival in Greece

Lung metastasis genes couple breast tumor size and metastatic spread

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