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Observational Study
. 2020 May;122(11):1618-1629.
doi: 10.1038/s41416-020-0784-z. Epub 2020 Mar 31.

Survival and disease characteristics of de novo versus recurrent metastatic breast cancer in a cohort of young patients

Hayley S McKenzie  1 , Tom Maishman  2 , Peter Simmonds  3 , Lorraine Durcan  2 ; POSH Steering Group; Diana Eccles #  3 , Ellen Copson #  3
Collaborators, Affiliations
Observational Study

Survival and disease characteristics of de novo versus recurrent metastatic breast cancer in a cohort of young patients

Hayley S McKenzie et al. Br J Cancer. 2020 May.

Abstract

Background: It is not clear how the pathology, presentation and outcome for patients who present with de novo metastatic breast cancer (dnMBC) compare with those who later develop distant metastases. DnMBC is uncommon in younger patients. We describe these differences within a cohort of young patients in the United Kingdom.

Methods: Women aged 40 years or younger with a first invasive breast cancer were recruited to the prospective POSH national cohort study. Baseline clinicopathological data were collected, with annual follow-up. Overall survival (OS) and post-distant relapse-free survival (PDRS) were assessed using Kaplan-Meier curves.

Results: In total, 862 patients were diagnosed with metastatic disease. DnMBC prevalence was 2.6% (76/2977). Of those with initially localised disease, 27.1% (786/2901) subsequently developed a distant recurrence. Median follow-up was 11.00 years (95% CI 10.79-11.59). Patients who developed metastatic disease within 12 months had worse OS than dnMBC patients (HR 2.64; 1.84-3.77). For PDRS, dnMBC was better than all groups, including those who relapsed after 5 years. Of dnMBC patients, 1.3% had a gBRCA1, and 11.8% a gBRCA2 mutation.

Conclusions: Young women with dnMBC have better PDRS than those who develop relapsed metastatic breast cancer. A gBRCA2 mutation was overrepresented in dnMBC.

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Conflict of interest statement

ERC declares honoraria from Roche, Astra-Zeneca, Pfizer, Lilly and Nanostring. DME declares honoraria from Astra-Zeneca and Pierre Fabre. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Kaplan-Meier plots of overall survival.
a OS for dnMBC vs. early 12, reference category: dnMBC. b OS for dnMBC vs. early 24, early 24– 60 and late60 + , reference category: dnMBC.
Fig. 2
Fig. 2. Kaplan-Meier plots of post-distant relapse-free survival.
a PDRS for dnMBC vs. early 12, reference category: dnMBC. b PDRS for dnMBC vs. early 24, early 24–60 and early 60 + , reference category: dnMBC. c Time-varying HR for PDRS for dnMBC vs. early12, reference category: dnMBC.
Fig. 3
Fig. 3. Kaplan-Meier plot of overall survival by surgical category.
OS by surgical type (dnMBC patients only); reference category: no surgery.
See this image and copyright information in PMC

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