Treatment of Primary Breast Cancer at the Surgical Unit of the Charité 1984-1998

Abstract

Background: We have analyzed the patient population of one clinic (Charité) over a period of 15 years. Besides the changes in the technical facilities and therapeutical guidelines during these years, this period also reflects the changes in the health system attributable to the reunification of East and West Germany. Until now only few analyses for breast cancer patients from the German speaking area have been reported. Patients and Methods: All 2,062 patients undergoing surgical treatment for breast cancer between 1984 and 1998 were documented and followed up until 2007. The analysis included 1,560 patients with a primary breast cancer who fulfilled certain inclusion criteria. The treatment strategies applied to this population are presented in 3 time periods (1984-1990, 1991-1993, and 1994-1998). The effects of prognostic factors on overall survival were investigated using univariate analyses. Results: The percentage of pT1 tumors changed from 50.7% in the first period to 63.1% in the third period. The percentage of node-negative patients hardly changed with time (on average 61.6%). However, the percentage of patients with less than 10 assessed nodes decreased from 48.4% to 6.7% and 2.5% for the 3 periods, respectively. Therapeutic strategies changed drastically. Survival rate increased substantially, most likely due to improved therapeutic strategies, but also for other reasons not considered in the analysis.

Improving the Prognostic Ability through Better Use of Standard Clinical Data - The Nottingham Prognostic Index as an Example

“…Accordingly, we excluded 502 patients, leaving 1560 patients for the analysis. Main reasons for exclusion were breast cancer in situ (n = 134) and age older than 80 years (n = 123), further reasons are briefly summarized in the REMARK type profile ( Table 1 ) and details can be found in Winzer et al [ 28 ]. We use data from clinical follow-up and consider overall survival (OS) with all causes of death as an event.…”

“…During 1984 and 1998 treatment of patients changed severely worldwide. Winzer et al [ 28 ] provide details about treatment strategies in three periods (1984–1990, 1991–1993, 1994–1998). During the first period, most of the patients (73.4%) had a mastectomy (±) radiotherapy and did not receive adjuvant treatments.…”

“…In the third period 61% had breast conserving treatment (±) radiotherapy and a systemic treatment. For details of local and adjuvant therapy, measurement techniques of prognostic factors, influence of prognostic factors on choice of treatment and further details concerning follow-up, we refer to Winzer et al [ 28 ] and cited references. To account for different treatment strategies, all Cox models were stratified according to therapy strata.…”

“…The patient records were not de-identified before entry in the original database. However, before starting the first analysis [ 28 ] KJW had received a positive vote by the authorized local data protection person for an analysis of the data base from breast cancer patients of the Charité Hospital. In addition this positive vote allows comparing follow-up data with the information given in the cancer registry and data from the residence registration office in Berlin.…”

“…The simplicity of the NPI is certainly an important criterion for its clinical relevance, but it also implies that some prognostic information may not be used to improve the NPI. Applying elaborated statistical methods–we explain the key ideas and cite relevant references but do not provide all details—to a clinical registry data set [ 28 ] we extract the full information of the data and derive a modified version of the NPI with improved prognostic ability. We will illustrate that the continuous variables tumor size and number of positive nodes exhibit more information and will investigate whether another six standard variables carry prognostic information in addition to the NPI.…”