Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Aug;116(3):595-602.
doi: 10.1007/s10549-008-0200-5. Epub 2008 Oct 2.

Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer

James J Dignam  1 , Vanja Dukic, Stewart J Anderson, Eleftherios P Mamounas, D Lawrence Wickerham, Norman Wolmark
Affiliations

Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer

James J Dignam et al. Breast Cancer Res Treat. 2009 Aug.

Abstract

Background: For patients with axillary lymph node-negative breast cancer, benefits from adjuvant therapy are smaller than in node-positive disease and thus more selective use is warranted, prompting development of risk profiling to identify those most likely to benefit. Examination of the magnitude and changes in the hazard of failure over time in node-negative breast cancer may also be informative in this regard.

Methods: Among 9,444 participants from five randomized trials (accrual 1982-1998) investigating chemotherapy and tamoxifen for node-negative breast cancer, we estimated recurrence hazards over time by tumor estrogen receptor (ER) status and adjuvant treatment.

Results: In patients treated by surgery only, we observed the previously noted larger hazard peak followed by a rapid decrease in ER-negative patients and smaller but more persistent hazard in ER-positive patients. After approximately 48 months, the ER-positive hazard is greater. For adjuvant treatment, while tamoxifen decreases the early hazard in ER-positive patients to that of the chemotherapy-treated ER-negative group, in later follow-up (beyond 5 years) the hazard for ER-positive patients again exceeds that of ER-negative patients. Adding chemotherapy to tamoxifen in ER-positive patients results in large early hazard reduction, but in later follow-up the hazard converges with those of patients treated by surgery only or tamoxifen.

Conclusions: Recurrence hazards over time reveal changes in risk that may have biologic and therapeutic strategy relevance. In ER-negative tumors, a large early chemotherapy benefit is followed by a consistently low recurrence hazard over time. In ER-positive patients, the chemotherapy benefit appears concentrated mostly in earlier follow-up, and a greater recurrence risk remains.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Recurrence hazards by ER-status for patients receiving surgery without systemic adjuvant therapy
Fig. 2
Fig. 2
Recurrence hazards for surgery and adjuvant systemic therapy in patients with ER-negative tumors
Fig. 3
Fig. 3
Recurrence hazards (top) and recurrence-free survival curves (bottom) for surgery and adjuvant systemic therapy in patients with ER-positive tumors
Fig. 4
Fig. 4
Recurrence hazards (top) and recurrence-free survival curves (bottom) by ER-status for patients receiving systemic adjuvant therapy
See this image and copyright information in PMC

References

    1. National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst Monogr. 2001;30:5–15. - PubMed
    1. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival. Lancet. 2005;365:1687–1717. - PubMed
    1. Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004;351:2817–2826. - PubMed
    1. Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24:3726–3734. - PubMed
    1. Robbins GF, Berg J. Curability of patients with invasive breast carcinoma based on a 30-year study. World J Surg. 1977;1:284–286. - PubMed

Publication types

MeSH terms