Risk of loco-regional recurrence and distant metastases of patients with invasive breast cancer up to ten years after diagnosis - results from a registry-based study from Germany

Abstract

Background: Population-based estimates of the long-term risk of loco-regional recurrence and distant metastases of breast cancer (BRC) patients are scant, as most published studies used hospital-based cohorts or participants of clinical trials. This work aims to extend available knowledge by providing population-based long-term estimates of the cumulative risk of BRC recurrence up to 10 years after diagnosis.

Methods: Data from the population-based Saarland Cancer Registry were used and included 9359 female patients with primary invasive BRC diagnosed between 1999 and 2009. Estimates of the cumulative incidence (CI) of BRC recurrence were derived for patients who had received local surgery with free resection margins by type of recurrence and stratified by age, tumor characteristics and major treatment options, taking into account mortality from any cause as a competing risk.

Results: The 10-year CI of BRC recurrence was 16%. For loco-regional recurrence and distant metastases alone it was 8 and 11%, respectively. The estimates showed substantial variation and were particularly increased if tumors were advanced (T1/2N+ 23%, T3/4N0 24%, T3/4N+ 34%), of high grade (23%), or of 'HER2/neu positive' (28%) or 'triple negative' subtype (23%), respectively.

Conclusions: The derived estimates reflect the risk of 'real world' patients and may therefore extend available knowledge. These data are thus of great relevance for clinicians, their patients and researchers. The study likewise demonstrated the usefulness of cancer registries for a population-based monitoring of the effectiveness of cancer care in terms of disease recurrence as a major treatment related outcome measure.

Keywords: Cancer registry; Cumulative incidence; Distant metastases; Germany; Invasive breast cancer; Loco-regional recurrence; Population-based.

Fig. 1

Ten-year cumulative incidence curves of cancer recurrence of female patients with primary invasive breast cancer. Cumulative incidence of cancer recurrence of breast cancer patients (ICD-10 code: C50) without distant metastases from Saarland after local R0 resection and diagnosed between 1999 and 2009 overall (subfigure a), by type of recurrence (b), age (c), clinical stage (d), histopathologic grade (e), morphologic type (f), hormone receptor expression (g), HER2/neu expression (h), and subtype based on immunohistochemical surrogates (i). T, N T and N category of TNM classification, HR hormone receptor, HER2/neu human epidermal growth factor receptor 2