Abstract P5-14-05: Improved Survival of Patients with Primary Distant Metastatic Breast Cancer in the Period of 1995 — 2007

Abstract

Introduction During the last fifteen years, important changes have taken place concerning the sy stemic treatment for patients with metastasized breast cancer. It would be interesting to know whether these improvements have also taken place patients with primary distant metastatic breast cancer. Additionally, several retrospective studies have shown an improvement in overall survival in patients who have received breast surgery. Therefore, we also analyzed the role of surgical resection of the primary breast tumor. Methods According to the database of the Dutch Cancer Registry 7,358 (5.0%) patients were diagnosed with primary distant metastases between 1997 and 2007. To establish whether improvement of prognosis had taken place, patients were divided into three periods of diagnosis, based on the year of diagnosis of their disease; 1995-1999, 2000-2003 and 2004-2007. The follow-up of these patients was completed until January 1, 2009. Results The median survival was 1.42 years for patients diagnosed in the period 1995-1999, 1.56 years in the period 2000-2003 and 2.0 years in the period 2004-2007. Only the difference between the periods 2000-2003 and 2004-2007 was statistically significant (P<0.0001). When analyzed according to age group, the improvement of the median survival was most pronounced for patients of 50 years or younger, with an increase of 2.18 to 3.01 years (P<0.0002). The median survival of the patients undergoing surgery was 2.5 years, compared to 1.3 years for the patients without surgical treatment of the primary tumor. Nevertheless, the proportion of patients who underwent a resection of the breast tumor decreased from 31% in the period 1995-1999 to 24% in the last period. In the multivariable analysis, the hazard ratio's (HRs) for mortality in the second and third period as compared to the first period were 0.95 (P=0.13) and 0.86 (P<0.0001), respectively. Older age and larger tumor size were associated with a higher mortality risk. Patients receiving systemic treatment (HR 0.36), locoregional radiotherapy (HR 0.79) or breast surgery (HR 0.65) had a significantly lower risk of death compared to the patients not receiving these treatments. Conclusion An improvement of six months is seen in the median survival of patients with primary distant metastatic breast cancer, resulting in a median survival of two years in 2007. Maybe, if surgery was more performed in the most recent time period, the improvement of the median survival was even better. However, it seems reasonable to argue that this improvement is due to new developments in systemic treatment. Figures available in online version. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-05.

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