J Clin Oncol. 2013 Jul 29. [Epub ahead of print]
Patterns of Recurrence and Outcome According to Breast Cancer Subtypes in Lymph Node-Negative Disease: Results From International Breast Cancer Study Group Trials VIII and IX.
Metzger-Filho O,
Sun Z,
Viale G,
Price KN,
Crivellari D,
Snyder RD,
Gelber RD,
Castiglione-Gertsch M,
Coates AS,
Goldhirsch A,
Cardoso F.
Source
Otto Metzger-Filho, Dana-Farber Cancer Institute; Zhuoxin Sun, Dana-Farber Cancer Institute, Harvard School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute, Harvard School of Public Health, Harvard Medical School; Karen N. Price, Frontier Science and Technology Research Foundation, Boston, MA; Giuseppe Viale, European Institute of Oncology and University of Milan; Aron Goldhirsch, European Institute of Oncology, Milan; Diana Crivellari, Centro di Riferimento Oncologico, Aviano, Italy; Raymond D. Snyder, St. Vincent's Hospital, Melbourne; Alan S. Coates, University of Sydney, Sydney, Australia; Monica Castiglione-Gertsch, University Hospital, Geneva; Alan S. Coates, International Breast Cancer Study Group, Bern, Switzerland; and Fatima Cardoso, Champalimaud Cancer Center, Lisbon, Portugal.
Abstract
PURPOSETo retrospectively evaluate the pattern of recurrence and outcome of node-negative breast cancer (BC) according to major subtypes. PATIENTS AND METHODSIn all, 1,951 patients with node-negative, early-stage BC randomly assigned in International Breast Cancer Study Group Trials VIII and IX with centrally reviewed pathology data were included. BC subtypes were defined as triple negative (TN; n = 310), human epidermal growth factor receptor 2 (HER2) positive (n = 369), and hormone receptor positive with high (luminal B-like [LB-like]; n = 763) or low (luminal A-like [LA-like]; n = 509) proliferative activity by Ki-67 labeling index. BC-free interval (BCFI) events were invasive BC recurrence in local, contralateral breast, nodal, bone, or visceral sites. Time to first site-specific recurrence was evaluated by using cumulative incidence and competing risks regression analysis.ResultsMedian follow-up was 12.5 years. The 10-year BCFI was higher for patients with LA-like (86%) BC compared with LB-like (76%), HER2 (73%), and TN (71%; P < .001) BC. TN and HER2 cohorts had higher hazard of BCFI event in the first 4 years after diagnosis (pre-trastuzumab). LB-like cohorts had a continuously higher hazard of BCFI event over time compared with LA-like cohorts. Ten-year overall survival was higher for LA-like (89%) compared with LB-like (83%), HER2 (77%), and TN (75%; P < .001) BC. LB-like subtypes had higher rates of bone as first recurrence site than other subtypes (P = .005). Visceral recurrence as first site was lower for the LA-like subgroup, with similar incidence among the other subgroups when treated with chemotherapy (P = .003). CONCLUSIONBC subtypes have different distant recurrence patterns over time. Defining different patterns of BC recurrence can improve BC care through surveillance guidelines and can guide the design of clinical studies.
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