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Open Access Highly Accessed Research article

Significant survival improvement of patients with recurrent breast cancer in the periods 2001-2008 vs. 1992-2000

Hideo Shigematsu1*, Hidetoshi Kawaguchi2, Yoshiaki Nakamura2, Kimihiro Tanaka2, Satoko Shiotani2, Chinami Koga2, Sumiko Nishimura2, Kenichi Taguchi3, Kenichi Nishiyama3 and Shinji Ohno2

Author Affiliations

1 Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan

2 Department of Breast Oncology, National Kyushu Cancer Center, Fukuoka, Japan

3 Department of Pathology, National Kyushu Cancer Center, Fukuoka, Japan

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BMC Cancer 2011, 11:118  doi:10.1186/1471-2407-11-118

Published: 31 March 2011

Abstract

Background

It is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer. The purpose of this study is to evaluate the survival improvement of patients with recurrent breast cancer after the introduction of third generation aromatase inhibitors (AIs) and trastuzumab.

Methods

A total of 407 patients who received first diagnosis of recurrent breast cancer and treatment at National Kyushu Cancer Center between 1992 and 2008 were retrospectively evaluated. As AIs and trastuzumab were approved for clinical use in Japan in 2001, the patients were divided into two time cohorts depending on whether the cancer recurred before or after 2001. Cohort A: 170 patients who were diagnosed between 1992 and 2000. Cohort B: 237 patients who were diagnosed between 2001 and 2008. Tumor characteristics, treatments, and outcome were compared.

Results

Fourteen percent of cohort A and 76% of cohort B received AIs and/or trastuzumab (P < 0.001). The median overall survival (OS) times after breast cancer recurrence were 1.7 years and 4.2 years for these respective cohorts (P < 0.001). Both the time period and treatment of AIs and/or trastuzumab for recurrent disease were significant prognostic factors in multivariate analysis (cohort B vs. cohort A: HR = 0.70, P = 0.01; AIs and/or trastuzumab for recurrent disease: yes vs. no: HR = 0.46, P < 0.001). When patients were categorized into 4 subgroups by the expression of hormone receptor (HR) and HER-2 status, the median OS times of the HR-positive/HER-2-negative, HR-positive/HER-2-positive, HR-negative/HER-2-positive, and HR-negative/HER-2-negative subtypes were 2.2, 2.4, 1.6, and 1.0 years in cohort A and 4.5, 5.1, 5.0, and 1.4 years in cohort B.

Conclusions

The prognosis of patients with recurrent breast cancer was improved over time following the introduction of AIs and trastuzumab and the survival improvement was apparent in HR- and/or HER-2-positive tumors.