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Breast Cancer Res Treat. 2018 Jan;167(2):579-590. doi: 10.1007/s10549-017-4529-5. Epub 2017 Oct 16.

Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010.

Author information

1
HealthStat Consulting, Inc, 12025 9th Ave NW, Seattle, WA, 98177, USA. jmalmgren@seanet.com.
2
School of Public Health, University of Washington, Seattle, WA, USA. jmalmgren@seanet.com.
3
Metastatic Breast Cancer Alliance, New York, NY, USA.
4
Swedish Cancer Institute, Seattle, WA, USA.

Abstract

BACKGROUND:

Differences in de novo (dnMBC) and recurrent metastatic breast cancer (rMBC) presentation and survival over time have not been adequately described.

METHODS:

A retrospective cohort study, 1990-2010, with follow up through 2015 of dnMBC patients (stage IV at diagnosis) and rMBC patients with subsequent distant metastatic recurrence (stage I-III initial diagnosis) [dnMBC = 247, rMBC = 911)]. Analysis included Chi squared tests of categorical variables, Kaplan-Meier survival estimates, and Cox proportional adjusted hazard ratios (HzR) and 95% confidence intervals (CI). Disease specific survival (DSS) was time from diagnosis or distant recurrence to BC death.

RESULTS:

Over time, 1990-1998, 1999-2004, and 2005-2010, dnMBC incidence was constant (3%) and rMBC incidence decreased [18% to 7% (p < 0.001)] with no change in dnMBC hormone receptor (HR) or her2-neu (HER2) status but a decrease in rMBC HER2-positive cases and increase in triple negative breast cancer (HR-negative/HER2-negative) (p = 0.049). Five-year dnMBC DSS was 44% vs. 21% for rMBC (p < 0.001). Five-year dnMBC DSS improved over time [28% to 55% (p = 0.008)] and rMBC worsened [23% to 13%, p = 0.065)]. Worse DSS was associated with HR-negative status (HzR = 1.63; 1.41, 1.89), rMBC (HzR = 1.88; 1.58, 2.23), older age (70 +) (HzR = 1.88; 1.58, 2.24), > 1 distant metastases (HzR 1.39; 1.20, 1.62), and visceral dominant disease (HzR 1.22; 1.05, 1.43). After 1998, HER2-positive disease was associated with better DSS (HzR = 0.72, 95% CI 0.56, 0.93).

CONCLUSIONS:

Factors associated with the widening survival gap and non-equivalence between dnMBC and rMBC and decreased rMBC incidence warrant further study.

KEYWORDS:

De novo; Distant relapse; Metastases; Metastatic breast cancer; Outcomes; Recurrence; Stage IV; Survival

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