Dynamics of the hazard for distant metastases after ipsilateral breast tumor recurrence according to estrogen receptor status: An analysis of 2851 patients

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Abstract

BACKGROUND: Breast cancer (BC) patients with ipsilateral breast tumor recurrence (IBTR) are at high risk of developing distant metastases (DM). We aimed to evaluate the risk pattern of developing DM, with respect to the occurrence of IBTR, in a large series of patients homogeneously treated by conservative surgery (QUART) with a considerably long follow-up.

METHODS: Piecewise exponential model was used to investigate DM dynamics conditioning on known prognostic factors and IBTR occurrence as time dependent covariate. The model was extended to account for the timescale induced by IBTR, namely the time elapsed since IBTR to the endpoint.

RESULTS: Among 2851 BCE patients receiving QUART, 209 were assessable for IBTR. After a median follow-up of 129 months, 588 patients presented DM (CCI = 27.3%) as first event and 92 (CCI = 48.8%) following IBTR. Primary tumor size and nodal status confirmed their prognostic value. The hazard for DM was early and high in Estrogen Receptor (ER) negative BC patients; while it was initially low but increases during follow-up in ER positive cases. Patients experiencing IBTR showed DM dynamic similar to that following primary tumor, with a sudden increased risk within 24 months from surgery, regardless the time elapsed since QUART.

CONCLUSION: BC patients experiencing IBTR showed a sudden and sustained risk of DM following surgery. Our findings are consistent with the hypothesis that IBTR occurrence might act as a "time resector" for risk of DM, and provide a rationale for proper surveillance guidelines and systemic therapy for optimizing BC recurrence and appropriate choice of treatment.

Original languageEnglish
Pages (from-to)131-135
Number of pages5
JournalBreast
Volume40
DOIs
Publication statusPublished - Aug 2018

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Estrogen Receptors
Breast Neoplasms
Neoplasm Metastasis
Recurrence
Neoplasms
Guidelines

Keywords

  • Adult
  • Breast Neoplasms/etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Mastectomy/adverse effects
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasms, Second Primary/etiology
  • Postoperative Complications/etiology
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Receptors, Estrogen/metabolism
  • Risk Factors
  • Time Factors

Cite this

@article{e6e38cd68547436f8273a30a3eac4845,
title = "Dynamics of the hazard for distant metastases after ipsilateral breast tumor recurrence according to estrogen receptor status: An analysis of 2851 patients",
abstract = "BACKGROUND: Breast cancer (BC) patients with ipsilateral breast tumor recurrence (IBTR) are at high risk of developing distant metastases (DM). We aimed to evaluate the risk pattern of developing DM, with respect to the occurrence of IBTR, in a large series of patients homogeneously treated by conservative surgery (QUART) with a considerably long follow-up.METHODS: Piecewise exponential model was used to investigate DM dynamics conditioning on known prognostic factors and IBTR occurrence as time dependent covariate. The model was extended to account for the timescale induced by IBTR, namely the time elapsed since IBTR to the endpoint.RESULTS: Among 2851 BCE patients receiving QUART, 209 were assessable for IBTR. After a median follow-up of 129 months, 588 patients presented DM (CCI = 27.3{\%}) as first event and 92 (CCI = 48.8{\%}) following IBTR. Primary tumor size and nodal status confirmed their prognostic value. The hazard for DM was early and high in Estrogen Receptor (ER) negative BC patients; while it was initially low but increases during follow-up in ER positive cases. Patients experiencing IBTR showed DM dynamic similar to that following primary tumor, with a sudden increased risk within 24 months from surgery, regardless the time elapsed since QUART.CONCLUSION: BC patients experiencing IBTR showed a sudden and sustained risk of DM following surgery. Our findings are consistent with the hypothesis that IBTR occurrence might act as a {"}time resector{"} for risk of DM, and provide a rationale for proper surveillance guidelines and systemic therapy for optimizing BC recurrence and appropriate choice of treatment.",
keywords = "Adult, Breast Neoplasms/etiology, Female, Follow-Up Studies, Humans, Mastectomy/adverse effects, Middle Aged, Neoplasm Metastasis, Neoplasms, Second Primary/etiology, Postoperative Complications/etiology, Prognosis, Randomized Controlled Trials as Topic, Receptors, Estrogen/metabolism, Risk Factors, Time Factors",
author = "Massimiliano Gennaro and {Di Cosimo}, Serena and Ilaria Ardoino and Silvia Veneroni and Luigi Mariani and Roberto Agresti and Daidone, {Maria Grazia} and {de Braud}, Filippo and Giovanni Apolone and Elia Biganzoli and Romano Demicheli",
note = "Copyright {\circledC} 2018 Elsevier Ltd. All rights reserved.",
year = "2018",
month = "8",
doi = "10.1016/j.breast.2018.05.004",
language = "English",
volume = "40",
pages = "131--135",
journal = "Breast",
issn = "0960-9776",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Dynamics of the hazard for distant metastases after ipsilateral breast tumor recurrence according to estrogen receptor status

T2 - An analysis of 2851 patients

AU - Gennaro, Massimiliano

AU - Di Cosimo, Serena

AU - Ardoino, Ilaria

AU - Veneroni, Silvia

AU - Mariani, Luigi

AU - Agresti, Roberto

AU - Daidone, Maria Grazia

AU - de Braud, Filippo

AU - Apolone, Giovanni

AU - Biganzoli, Elia

AU - Demicheli, Romano

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/8

Y1 - 2018/8

N2 - BACKGROUND: Breast cancer (BC) patients with ipsilateral breast tumor recurrence (IBTR) are at high risk of developing distant metastases (DM). We aimed to evaluate the risk pattern of developing DM, with respect to the occurrence of IBTR, in a large series of patients homogeneously treated by conservative surgery (QUART) with a considerably long follow-up.METHODS: Piecewise exponential model was used to investigate DM dynamics conditioning on known prognostic factors and IBTR occurrence as time dependent covariate. The model was extended to account for the timescale induced by IBTR, namely the time elapsed since IBTR to the endpoint.RESULTS: Among 2851 BCE patients receiving QUART, 209 were assessable for IBTR. After a median follow-up of 129 months, 588 patients presented DM (CCI = 27.3%) as first event and 92 (CCI = 48.8%) following IBTR. Primary tumor size and nodal status confirmed their prognostic value. The hazard for DM was early and high in Estrogen Receptor (ER) negative BC patients; while it was initially low but increases during follow-up in ER positive cases. Patients experiencing IBTR showed DM dynamic similar to that following primary tumor, with a sudden increased risk within 24 months from surgery, regardless the time elapsed since QUART.CONCLUSION: BC patients experiencing IBTR showed a sudden and sustained risk of DM following surgery. Our findings are consistent with the hypothesis that IBTR occurrence might act as a "time resector" for risk of DM, and provide a rationale for proper surveillance guidelines and systemic therapy for optimizing BC recurrence and appropriate choice of treatment.

AB - BACKGROUND: Breast cancer (BC) patients with ipsilateral breast tumor recurrence (IBTR) are at high risk of developing distant metastases (DM). We aimed to evaluate the risk pattern of developing DM, with respect to the occurrence of IBTR, in a large series of patients homogeneously treated by conservative surgery (QUART) with a considerably long follow-up.METHODS: Piecewise exponential model was used to investigate DM dynamics conditioning on known prognostic factors and IBTR occurrence as time dependent covariate. The model was extended to account for the timescale induced by IBTR, namely the time elapsed since IBTR to the endpoint.RESULTS: Among 2851 BCE patients receiving QUART, 209 were assessable for IBTR. After a median follow-up of 129 months, 588 patients presented DM (CCI = 27.3%) as first event and 92 (CCI = 48.8%) following IBTR. Primary tumor size and nodal status confirmed their prognostic value. The hazard for DM was early and high in Estrogen Receptor (ER) negative BC patients; while it was initially low but increases during follow-up in ER positive cases. Patients experiencing IBTR showed DM dynamic similar to that following primary tumor, with a sudden increased risk within 24 months from surgery, regardless the time elapsed since QUART.CONCLUSION: BC patients experiencing IBTR showed a sudden and sustained risk of DM following surgery. Our findings are consistent with the hypothesis that IBTR occurrence might act as a "time resector" for risk of DM, and provide a rationale for proper surveillance guidelines and systemic therapy for optimizing BC recurrence and appropriate choice of treatment.

KW - Adult

KW - Breast Neoplasms/etiology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Mastectomy/adverse effects

KW - Middle Aged

KW - Neoplasm Metastasis

KW - Neoplasms, Second Primary/etiology

KW - Postoperative Complications/etiology

KW - Prognosis

KW - Randomized Controlled Trials as Topic

KW - Receptors, Estrogen/metabolism

KW - Risk Factors

KW - Time Factors

U2 - 10.1016/j.breast.2018.05.004

DO - 10.1016/j.breast.2018.05.004

M3 - Article

C2 - 29772517

VL - 40

SP - 131

EP - 135

JO - Breast

JF - Breast

SN - 0960-9776

ER -