Survival of older patients with metastasised breast cancer lags behind despite evolving treatment strategies – A population-based study

Glas, Nienke A. de; Bastiaannet, E.; Craen, Anton J. M. de; Velde, Cornelis J.H. van de; Siesling, Sabine; Liefers, G.J.; Portielje, Johanneke E.A.

doi:10.1016/j.ejca.2014.11.021

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…The increasing application of novel cancer treatments including chemotherapy, endocrine therapy, and molecular-targeted therapy has improved the survival of metastatic BC patients (18)(19)(20). These treament advances have resulted in decreasing recurrence rates for early-stage breast cancer (3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

The Difference in Prognostic Outcomes Between De Novo Stage IV and Recurrent Metastatic Patients with Hormone Receptor-positive, HER2-negative Breast Cancer

Yamamura

Kamigaki

Fujita

et al. 2018

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Abstract. Background Breast cancer (BC) is the most common malignancy diagnosed in women, and leads to cancer mortality worldwide (1, 2). The majority of BC patients are diagnosed at an early disease stage, receive surgery and adjuvant treatment, and become long-term survivors who can be classified as disease-free (3-5). However, patients that develop metastatic disease during or after standard of care are generally incurable. In these cases a primary treatment goal is symptom palliation (6, 7). Patients with distant metastasis at initial diagnosis are classified as de novo stage IV metastatic patients and can be viewed as a distinct subgroup (8, 9), and these patients could be considered a poor prognostic group with incurable disease. However, a previous report suggested that de novo BC patients tend to have a better prognosis relative to recurrent BC patients (10). De novo BC patients may have a better response to systemic therapy due to their treatment-naïve status, while recurrent BC patients are more likely to show therapeutic resistance to systemic therapy after undergoing adjuvant treatment. There could also be biological differences other than the therapeutic factors between de novo and recurrent BC patients (11-13). Metastatic BC patients could form heterogeneous groups and present with varying metastatic patterns and prognostic outcomes, therefore requiring distinct treatment approaches based on BC subtype (14, 15). Treatment strategies have continuously advanced thanks to improved understanding of the heterogeneity of metastatic disease, which can have distant patterns of recurrence and varying prognostic impacts (15, 16). These approaches, which include endocrine therapies, targeted therapies, and various types of chemotherapies, are selected according to metastatic and prognostic patterns or BC subtypes based on immunohistochemical or molecular classifications (17). Although the difference in metastatic patterns and survival outcomes between de novo and recurrent BC patients is still unclear, these patients have often been treated with the same strategies. The objective of this retrospective study is to examine the prognostic outcomes between these groups of patients, both with the hormone receptor positive (HR+), and HER2-negative (HER2-) subtype. A better understanding of the metastatic course and prognostic factors for these patients 353

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Section: Discussionmentioning

confidence: 99%

The Difference in Prognostic Outcomes Between De Novo Stage IV and Recurrent Metastatic Patients with Hormone Receptor-positive, HER2-negative Breast Cancer

Yamamura

Kamigaki

Fujita

et al. 2018

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“…[3][4][5] The survival of de novo metastatic disease has improved with more prevalent use of novel oncology drug treatments such as endocrine therapy and monoclonal antibodies. [6][7][8] Retrospective studies have also shown that local treatment, including surgery and radiotherapy, can improve survival in stage-IV breast cancer patients. [9][10][11][12][13] In patients diagnosed with advanced breast cancer during follow-up, the most common metastatic sites were bone, followed by lung, liver, and brain.…”

Section: Introductionmentioning

confidence: 99%

The effect of distant metastases sites on survival in de novo stage-IV breast cancer: A SEER database analysis

Li²,

Tang

et al. 2017

Tumour Biol.

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To investigate the effect of distant metastases sites on survival in patients with de novo stage-IV breast cancer. From 2010 to 2013, patients with a diagnosis of de novo stage-IV breast cancer were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were performed to analyze the effect of distant metastases sites on breast cancer-specific survival and overall survival. A total of 7575 patients were identified. The most common metastatic sites were bone, followed by lung, liver, and brain. Patients with hormone receptor+/human epidermal growth factor receptor 2- and hormone receptor+/human epidermal growth factor receptor 2+ status were more prone to bone metastases. Lung and brain metastases were common in hormone receptor-/human epidermal growth factor receptor 2+ and hormone receptor-/human epidermal growth factor receptor 2- subtypes, and patients with hormone receptor+/ human epidermal growth factor receptor 2+ and hormone receptor-/human epidermal growth factor receptor 2+ subtypes were more prone to liver metastases. Patients with liver and brain metastases had unfavorable prognosis for breast cancer-specific survival and overall survival, whereas bone and lung metastases had no effect on patient survival in multivariate analyses. The hormone receptor-/human epidermal growth factor receptor 2- subtype conferred a significantly poorer outcome in terms of breast cancer-specific survival and overall survival. hormone receptor+/human epidermal growth factor receptor 2+ disease was associated with the best prognosis in terms of breast cancer-specific survival and overall survival. Patients with liver and brain metastases were more likely to experience poor prognosis for breast cancer-specific survival and overall survival by various breast cancer subtypes. Distant metastases sites have differential impact on clinical outcomes in stage-IV breast cancer. Follow-up screening for brain and liver metastases might be effective in improving breast cancer-specific survival and overall survival.

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“…Despite this favorable trend, survival did not increase in the 70 – 84 year group or in the subgroup with metastatic tumors at diagnosis. Adjuvant treatment, one of the factors responsible for this trend, is less effective for this stage and age group [ 70 ]. Women older than 70 years also have more comorbidities, and breast-conserving surgery plus adjuvant therapy are used to a lesser extent; both of these factors are related to decreased survival [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study

et al. 2018

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BackgroundThe incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants.MethodsData were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage.ResultsOverall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases × 100,000 women in 1985–1989 to 83.4 in 2008–2012, with an annual percentage change (APC) of 2.5% (95%CI, 2.1–2.9) for 1985–2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%CI, 2.4–4.8). For 2000–2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%CI, 1.9–5.8). Overall age-adjusted breast cancer mortality decreased (APC − 1, 95%CI, − 1.4 – − 0.5), as did mortality in the 50–69 year age group (APC − 1.3, 95%CI, − 2.2 – − 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985–1989 to 83.7% in 2010–2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 23.3% for stage IV.ConclusionsBreast cancer incidence is increasing – a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50–69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70–84 year age group and for metastatic tumors.

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Survival of older patients with metastasised breast cancer lags behind despite evolving treatment strategies – A population-based study

Cited by 13 publications

References 27 publications

The Difference in Prognostic Outcomes Between De Novo Stage IV and Recurrent Metastatic Patients with Hormone Receptor-positive, HER2-negative Breast Cancer

The Difference in Prognostic Outcomes Between De Novo Stage IV and Recurrent Metastatic Patients with Hormone Receptor-positive, HER2-negative Breast Cancer

The effect of distant metastases sites on survival in de novo stage-IV breast cancer: A SEER database analysis

Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study

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