Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: recurrence, metastases, second cancer and death

Abstract

BackgroundIn the setting of recurrent events, research studies commonly count only the first occurrence of an outcome in a subject. However this approach does not correctly reflect the natural history of the disease. The objective is to jointly identify prognostic factors associated with locoregional recurrences (LRR), contralateral breast cancer, distant metastases (DM), other primary cancer than breast and breast cancer death and to evaluate the correlation between these events.MethodsPatients (n = 919) with a primary invasive breast cancer and treated in a cancer center in South-Western France with breast-conserving surgery from 1990 to 1994 and followed up to January 2006 were included. Several types of non-independent events could be observed for the same patient: a LRR, a contralateral breast cancer, DM, other primary cancer than breast and breast cancer death. Data were analyzed separately and together using a random-effects survival model.ResultsLRR represent the most frequent type of first failure (14.6%). The risk of any event is higher for young women (less than 40 years old) and in the first 10 years of follow-up after the surgery. In the combined analysis histological tumor size, grade, number of positive nodes, progesterone receptor status and treatment combination are prognostic factors of any event. The results show a significant dependence between these events with a successively increasing risk of a new event after the first and second event. The risk of developing a new failure is greatly increased (RR = 4.25; 95%CI: 2.51-7.21) after developing a LRR, but also after developing DM (RR = 3.94; 95%CI: 2.23-6.96) as compared to patients who did not develop a first event.ConclusionWe illustrated that the random effects survival model is a more satisfactory method to evaluate the natural history of a disease with multiple type of events.

Analysis of Trends and Factors in Breast Multiple Primary Malignant Neoplasms

“…In a study of the survival time of MPMN, second primary small-cell lung cancer (SCLC) was compared with first primary SCLC, and no significant differences were found in efficacy and median survival time. 27,28…”

“…In a study of the survival time of MPMN, second primary small-cell lung cancer (SCLC) was compared with first primary SCLC, and no significant differences were found in efficacy and median survival time. 27,28 Although there is not yet a consensus of prognostic factors of MPMN, several studies have shown consistent prognostic factors, including the MPMN occurrence interval, earlier or later stage of the disease and tumor type, biological characteristics, and whether or not diagnosis and correct treatment are applied in a timely manner, including radical surgery, adjuvant chemotherapy, and radiotherapy. The definition of SMPMN and MMPMN is the starting point to achieve accurate comparisons, and 6 months is the standard criterion used in most previous studies.…”

“…For instance, in the structure of BC incidence, the proportion of young and average age groups (25-39 years) increased by 4 percentage points; they have shown high birth activity in recent years. Women of an early age (15)(16)(17)(18)(19) and those of an early reproductive age (25)(26)(27)(28)(29) contributed to ovary cancer incidence, with its indicator increasing by 3.7 percentage points. However, malignant growths of the mentioned organs did not result in permanent loss of reproductive function, which can be restored provided proper treatment is given.…”

Clinical retrospective analysis of cases with multiple primary malignant neoplasms

“…The mechanism might be associated with chemotherapy drug-induced DNA-protein crosslinkages and/or DNA strand breaks and cell transformations, mutations, and chromosomal aberrations (Noronha et al, 2006). Patients with malignant tumors generally receive long-term chemicals for anticancer treatment and high-dose hormone therapy, resulting in decreased immune function, thus making them more prone to cancer (Rondeau et al, 2010). Immune reconstitution after systemic chemotherapy is not only important for the prevention of cancer recurrence and metastasis, but is also an important measure for the prevention of the occurrence of multiple primary cancers.…”

18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques

“…Distant metastases at diagnosis are more frequently seen in patients with large tumors or axillary lymph node metastases [7,8]. Therefore, it is standard practice to perform a search for distant disease prior to an intensive treatment regime with curative intent [9,10].…”