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. 2014 Mar 4;110(5):1378-84.
doi: 10.1038/bjc.2014.5. Epub 2014 Jan 16.

Time-dependent risk of developing distant metastasis in breast cancer patients according to treatment, age and tumour characteristics

E Colzani  1 , A L V Johansson  1 , A Liljegren  2 , T Foukakis  2 , M Clements  1 , J Adolfsson  3 , P Hall  1 , K Czene  1
Affiliations

Time-dependent risk of developing distant metastasis in breast cancer patients according to treatment, age and tumour characteristics

E Colzani et al. Br J Cancer. .

Abstract

Background: Metastatic breast cancer is a severe condition without curative treatment. How relative and absolute risk of distant metastasis varies over time since diagnosis, as a function of treatment, age and tumour characteristics, has not been studied in detail.

Methods: A total of 9514 women under the age of 75 when diagnosed with breast cancer in Stockholm and Gotland regions during 1990-2006 were followed up for metastasis (mean follow-up=5.7 years). Time-dependent development of distant metastasis was analysed using flexible parametric survival models and presented as hazard ratio (HR) and cumulative risk.

Results: A total of 995 (10.4%) patients developed distant metastasis; the most common sites were skeleton (32.5%) and multiple sites (28.3%). Women younger than 50 years at diagnosis, with lymph node-positive, oestrogen receptor (ER)-negative, >20 mm tumours and treated only locally, had the highest risk of distant metastasis (0-5 years' cumulative risk =0.55; 95% confidence interval (CI): 0.47-0.64). Women older than 50 years at diagnosis, with ER-positive, lymph node-negative and ≤20-mm tumours, had the same and lowest cumulative risk of developing metastasis 0-5 and 5-10 years (cumulative risk=0.03; 95% CI: 0.02-0.04). In the period of 5-10 years after diagnosis, women with ER-positive, lymph node-positive and >20-mm tumours were at highest risk of distant recurrence. Women with ER-negative tumours showed a decline in risk during this period.

Conclusion: Our data show no support for discontinuation at 5 years of clinical follow-up in breast cancer patients and suggest further investigation on differential clinical follow-up for different subgroups of patients.

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Figures

Figure 1
Figure 1
Estimated rates of first distant metastasis within 10 years of diagnosis of first invasive breast cancer in women diagnosed between 1990 and 2006 in Stockholm–Gotland Swedish counties, according to age and tumour characteristics.
See this image and copyright information in PMC

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