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01-09-2009 | Epidemiology

The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

Authors: G. H. de Bock, H. Putter, J. Bonnema, J. A. van der Hage, H. Bartelink, C. J. van de Velde

Published in: Breast Cancer Research and Treatment | Issue 2/2009

Abstract

To study whether the effects of prognostic factors associated with the occurrence of distant metastases (DM) at primary diagnosis change after the incidence of loco-regional recurrences (LRR) among women treated for invasive stage I or II breast cancer. The study population consisted of 3,601 women, enrolled in EORTC trials 10801, 10854, or 10902 treated for early-stage breast cancer. Data were analysed in a multivariate, multistate model by using multivariate Cox regression models, including a state-dependent covariate. The presence of a LRR in itself is a significant prognostic risk factor (HR: 3.64; 95%-CI: 2.02–6.5) for the occurrence of DM. Main prognostic risk factors for a DM are young age at diagnosis (≤40: HR: 1.79; 95%-CI: 1.28–2.51), larger tumour size (HR: 1.58; 95%-CI: 1.35–1.84) and node positivity (HR: 2.00; 95%-CI: 1.74–2.30). Adjuvant chemotherapy is protective for a DM (HR: 0.66; 95%-CI: 0.55–0.80). After the occurrence of a LRR the latter protective effect has disappeared (P = 0.009). The presence of LRR in itself is a significant risk factor for DM. For patients who are at risk of developing LRR, effective local control should be the main target of therapy.

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Title: The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model
Authors: G. H. de Bock
H. Putter
J. Bonnema
J. A. van der Hage
H. Bartelink
C. J. van de Velde
Publication date: 01-09-2009
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2009
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-008-0300-2

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