Improvements in breast cancer survival over time, related to adjuvant treatment and node status

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Abstract

Background

There has been an increase in the use and effectiveness of adjuvant treatment for operable breast cancer and the aim of this study was to examine whether this has resulted in improved survival for all prognostic groups.

Methods

A retrospective study of 1517 patients with invasive breast cancer treated between 1980 and 2002 was carried out. The use of adjuvant treatment was compared between two time periods in patients based on nodal status, and survival was calculated by Kaplan–Meier life table analysis. Independent predictors for recurrence-free survival (RFS) were determined by Cox regression analysis.

Results

The use of adjuvant therapy increased for all prognostic groups. On multivariate analysis the use of radiotherapy and endocrine therapy was positively associated with RFS which was significant in the second time period. Outcome in node positive patients improved: five-year RFS from 59% to 76%, p < 0.01 and breast cancer specific survival (BCSS) from 70% to 83%, p < 0.01. However, there was no survival improvement in the larger group of node negative patients; BCSS 93% versus 95%, p = 0.99. Within the node negative group, patients with tumours  2 cm had an improved RFS from 80% to 88%, p = 0.02.

Conclusion

The increased use of adjuvant therapy was associated with an improved outcome in node positive patients. For node negative patients with good prognostic features the evidence of benefit was marginal.

Introduction

Breast cancer survival is improving1 and studies have shown that use of adjuvant treatment is one of the main reasons. Chemotherapeutic drugs have become increasingly effective over the past decades and have produced a significant reduction in breast cancer mortality rates.2, 3 This, in turn, has led to a general rise in the use of systemic adjuvant therapies.4 But, depending on stage of the disease and tumour characteristics, there has been debate about the indications for and absolute benefit from adjuvant treatment in different prognostic groups.

The present study examined two groups of patients, those who were node negative and those who were node positive at the time of diagnosis. The aim was to compare the use of adjuvant therapy between two time periods and to relate changes to differences in breast cancer recurrence and survival.

Section snippets

Patient selection

The study was a review of breast cancer patients diagnosed between 1980 and 2002. Patient details were collected prospectively on an actively managed database and the follow-up is near-complete. Only patients with operable breast cancer were included in the study and those who had no node status recorded, solely in situ carcinoma or bilateral disease were excluded.

Tumour characteristics and adjuvant treatment

The remaining 1517 patients were divided into two groups according to the nodal status at the time of diagnosis. The following data

Overall survival improvement

There was a significant improvement in RFS and BCSS when comparing the two time periods 1980–1995 and 1996–2002. RFS increased from 76% to 85% (HR 1.63, 95% CI 1.32–2.01, p < 0.01), and BCSS from 84% to 90% (HR 1.4, 95% CI 1.1–1.82, p < 0.01). Use of adjuvant therapy was significantly increased during the latter period, in both node positive and node negative patients including prognostic subgroups (Table 1). In Cox regression analysis the use of adjuvant radiotherapy and endocrine therapy were

Adjuvant treatment and survival in node positive patients

The present study shows that breast cancer recurrence rates and survival have significantly improved over time, correlating with a general increase in the use of adjuvant treatment in all prognostic groups. The importance of the increasing use of adjuvant radiotherapy and endocrine therapy on RFS in the second time period was confirmed in a multivariate analysis. The increased use of adjuvant chemotherapy did not show a significant improvement in the outcome although there was a switch from CMF

Conclusion

Adjuvant treatment is effective in reducing recurrence and mortality in node positive breast cancer patients and in node negative patients with larger tumours. The outcome in node negative patients with low grade and small-sized tumours is very good and it is difficult to improve on an already good prognosis in this patient group.

Conflict of interest

There were no conflicts of interests.

References (18)

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