Breast cancer stage, receptor status may help predict recurrence risk
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Key findings:
- Researchers observed significant variations in time to first recurrence between receptor-type groups (P < .0001), and stage influenced the time to recurrence within each receptor-type group.
- Three-quarters of recurrences occurred within 1.92 years of study baseline among patients with triple-negative breast cancer, whereas 75% occurred within 3.05 years of baseline among patients with triple-positive disease.
Breast cancer stage and receptor status appeared to predict risk for recurrence among patients with stage I to stage III disease, according to study results published in Cancer.
Researchers suggested consideration of anatomic stage and receptor status in follow-up recommendations for these patients.
Methodology
Heather B. Neuman, MD, MS, associate professor in the department of surgery at University of Wisconsin School of Medicine and Public Health, and colleagues sought to assess the association of anatomic stage and receptor status with timing of the first recurrence for patients with local‐regional breast cancer and to develop risk‐stratified follow‐up recommendations.
The study included 8,007 patients (mean age, 54.3 years; 85.5% white) with stage I (30.3%), stage II (50.2%) or stage III (19.5%) breast cancer who participated in nine clinical trials between 1997 and 2013 and received standard-of-care-treatment.
Days from the earliest treatment start date to the date of first recurrence served as the primary outcome. Researchers used anatomic stage as the primary explanatory variable and stratified the analysis by receptor type. In addition, they used Cox proportional‐hazards regression models to produce cumulative probabilities of recurrence, and a dynamic programming algorithm approach to optimize intervals of follow-up timing based on the timing of recurrence events.
Median follow-up was 4.68 years.
Findings
Overall, 56% of patients had ER-positive or PR-positive, HER2-negative disease and approximately 29% had HER2-positive disease.
Results showed 10% of the overall cohort experienced recurrence at 5-year follow-up. Researchers observed a 45.5% risk for recurrence among those with stage III ER- and PR-negative, HER2-negative tumors compared with a 15.3% risk among those with stage III ER- and PR-positive, HER2-positive tumors.
The majority of first recurrences included a distant recurrence (69.2%) — 61% had distant recurrences alone and 8.2% had simultaneous recurrences — and 30.8% experienced local-regional recurrences alone.
Researchers observed significant variations in time to first recurrence between receptor-type groups (P < .0001), and stage influenced the time to recurrence within each receptor-type group.
In addition, researchers found 75% of recurrences occurred within 1.92 years of study baseline among patients with triple-negative breast cancer. Conversely, patients with triple-positive disease experienced the longest time to recurrence, with 75% occurring by 3.05 years from baseline.
Moreover, 75% of recurrences occurred by 2.65 years among those with ER-positive or PR-positive, HER2-negative disease and by 2.79 years among those with ER-negative and PR-negative, HER2-positive disease.
Implications
The findings highlight the need for a more personalized approach to follow-up care among breast cancer survivors, according to the researchers.
“We have demonstrated a compelling need for the development and implementation of risk‐stratified follow‐up guidelines,” they wrote. “Our data establish that significant differences in absolute risk and timing of recurrence exist based on anatomic stage and receptor subtype. Furthermore, we have translated our findings into data‐driven recommendations for follow‐up. Implementation of risk‐ stratified guidelines based on our data has the potential to have a strong, positive impact on both survivors and their oncology providers.”
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