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. 2022 Jan 29:44:101282.
doi: 10.1016/j.eclinm.2022.101282. eCollection 2022 Feb.

De novo and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995

S J Lord  1   2   3 , K Bahlmann  1 , D L O'Connell  4   5 , B E Kiely  2 , B Daniels  3   6 , S A Pearson  3   6 , J Beith  7 , M K Bulsara  8 , N Houssami  9
Affiliations

De novo and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995

S J Lord et al. EClinicalMedicine. .

Abstract

Background: Advances in breast cancer (BC) care have reduced mortality, but their impact on survival once diagnosed with metastasis is less well described. This systematic review aimed to describe population-level survival since 1995 for de novo metastatic BC (dnMBC) and recurrent MBC (rMBC).

Methods: We searched MEDLINE 01/01/1995-12/04/2021 to identify population-based cohort studies of MBC reporting overall (OS) or BC-specific survival (BCSS) over time. We appraised risk-of-bias and summarised survival descriptively for MBC diagnoses in 5-year periods from 1995 until 2014; and for age, hormone receptor and HER2 subgroups.

Findings: We identified 20 eligible studies (14 dnMBC, 1 rMBC, 5 combined). Potential sources of bias in these studies were confounding and shorter follow-up for the latest diagnosis period.For dnMBC, 13 of 14 studies reported improved OS or BCSS since 1995. In 2005-2009, the median OS was 26 months (range 24-30), a median gain of 6 months since 1995-1999 (range 0-9, 4 studies). Median 5-year OS was 23% in 2005-2009, a median gain of 7% since 1995-1999 (range -2 to 14%, 4 studies). For women ≥70 years, the median and 5-year OS was unchanged (1 study) with no to modest difference in relative survival (range: -1·9% (p = 0.71) to +2·1% (p = 0.045), 3 studies). For rMBC, one study reported no change in survival between 1998 and 2006 and 2007-2013 (median OS 23 months). For combined MBC, 76-89% had rMBC. Three of four studies observed no change in median OS after 2000. Of these, one study reported median OS improved for women ≤60 years (1995-1999 19·1; 2000-2004 22·3 months) but not >60 years (12·7, 11·6 months).

Interpretation: Population-level improvements in OS for dnMBC have not been consistently observed in rMBC cohorts nor older women. These findings have implications for counselling patients about prognosis, planning cancer services and trial stratification.

Funding: SL was funded in part by a National Health and Medical Research Council (NHMRC) Project Grant ID: 1125433. NH was funded by the NBCF Chair in Breast Cancer Prevention grant (EC-21-001) and a NHMRC Investigator (Leader) grant (194410). BD and SAP were funded in part by the NHMRC Centre of Research Excellence in Medicines Intelligence (1196900).

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Conflict of interest statement

SJL received grant funding for research support from the National Health and Medical Research Foundation (NHMRC). BEK received funding for: advisory board participation (Roche and Gilead); an educational presentation (Novartis); meeting registration fees (Novartis). SAP received funding for post-market surveillance research (AbbVie). JB received funding for conference attendance (Novartis). NH received grant funding for research support from: the National Breast Cancer Foundation (NBCF) and NHMRC; and honoraria for journal editorial work (Elsevier). All remaining authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection MBC=metastatic breast cancer.
Figure 2
Figure 2
Survival over time for de novo MBC: (A) median overall survival; (B) median breast cancer-specific survival; (C) 5-year overall survival; (D) 5-year breast cancer-specific survival, relative survival BCSS = breast cancer specific survival; MBC = metastatic breast cancer Where more than one study reported OS from the same region, we selected the study that included the most recent study period.
Figure 2
Figure 2
Survival over time for de novo MBC: (A) median overall survival; (B) median breast cancer-specific survival; (C) 5-year overall survival; (D) 5-year breast cancer-specific survival, relative survival BCSS = breast cancer specific survival; MBC = metastatic breast cancer Where more than one study reported OS from the same region, we selected the study that included the most recent study period.
Figure 3
Figure 3
Survival over time for recurrent and combined (de novo and recurrent) MBC: (A) median overall survival, (B) 5-year overall survival.
See this image and copyright information in PMC

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