J Breast Cancer.  2018 Mar;21(1):70-79. 10.4048/jbc.2018.21.1.70.

Chronological Improvement in Survival of Patients with Breast Cancer: A Large-Scale, Single-Center Study

Affiliations
  • 1Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ahnsh@amc.seoul.kr
  • 2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
This study aimed to chronologically evaluate survival of patients with breast cancer in Korea and investigate the observed changes during the last 20 years. We also sought to determine factors that may influence outcomes and changes in the duration of survival over time.
METHODS
We retrospectively analyzed a total of 10,988 patients with breast cancer who were treated at our institution between January 1993 and December 2008. We divided the study period into three periods (P1, 1993-1997; P2, 1998-2002; and P3, 2003-2008). We retrospectively reviewed the collected data from the Asan database, including age at diagnosis, clinical manifestations, pathology report, surgical methods, types of adjuvant treatment modalities, type of recurrence, and follow-up period.
RESULTS
At a median follow-up of 8.2 years, we observed that survival outcomes have improved recently. The 5-year breast cancer-specific survival (BCSS) rate also increased from 82.8% in P1 to 92.6% in P3 (p < 0.001). The survival rate in patients with tumors at each stage increased in similar patterns in all patients, and, remarkably, there was a significant survival improvement in patients with stage III breast cancer (P1 vs. P3: 5-year BCSS, 57.4% vs. 80.0%, p < 0.001). The time period was a significant prognostic factor in multivariate analysis (P1 vs. P2: hazard ratio [HR], 0.83, p=0.035; P1 vs. P3: HR, 0.75, p=0.015).
CONCLUSION
The study results suggest an improvement in breast cancer survival in Korea, which is consistent with the development of treatments and early detection.

Keyword

Breast neoplasms; Prognosis; Recurrence; Survival

MeSH Terms

Breast Neoplasms*
Breast*
Chungcheongnam-do
Diagnosis
Follow-Up Studies
Humans
Korea
Multivariate Analysis
Pathology
Prognosis
Recurrence
Retrospective Studies
Survival Rate

Figure

  • Figure 1 Chronological changes of survival in patients with primary breast cancer. Disease-free survival (DFS) (A), overall survival (OS) (B), and breast cancer-specific survival (BCSS) (C) of breast cancer according to periods at diagnosis in overall series.

  • Figure 2 Chronological changes of survival in patients with primary breast cancer according to stage. Subgroup analyses of breast cancer-specific survival (BCSS) by stage, stage 0 (A), stage I (B), stage II (C), stage III (D), and stage IV (E). Subgroup analyses of disease-free survival (DFS) by stage, stage 0 (F), stage I (G), stage II (H), and stage III (I).

  • Figure 3 Disease-free survival (DFS) according to recurrence type in patients with breast cancer. DFS according to periods at diagnosis in overall series. Local DFS (A), regional DFS (B), and systemic DFS (C).

  • Figure 4 Disease-free survival (DFS) according to recurrence type in patients with breast cancer by stage. DFS according to periods at diagnosis in stage I (A-C), stage II (D-F), and stage III (G-I).


Reference

1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61:69–90. PMID: 21296855.
Article
2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55:74–108. PMID: 15761078.
Article
3. Ahn SH, Yoo KY. Korean Breast Cancer Society. Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996–2004. Breast Cancer Res Treat. 2006; 99:209–214. PMID: 16862450.
Article
4. Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet. 2011; 378:1461–1484. PMID: 21924486.
Article
5. Shin HR, Joubert C, Boniol M, Hery C, Ahn SH, Won YJ, et al. Recent trends and patterns in breast cancer incidence among Eastern and Southeastern Asian women. Cancer Causes Control. 2010; 21:1777–1785. PMID: 20559704.
Article
6. Ko SS. Korean Breast Cancer Society. Chronological changing patterns of clinical characteristics of Korean breast cancer patients during 10 years (1996–2006) using nationwide breast cancer registration on-line program: biannual update. J Surg Oncol. 2008; 98:318–323. PMID: 18623175.
Article
7. Park EH, Min SY, Kim Z, Yoon CS, Jung KW, Nam SJ, et al. Basic facts of breast cancer in Korea in 2014: the 10-year overall survival progress. J Breast Cancer. 2017; 20:1–11. PMID: 28382089.
Article
8. You JM, Kim YG, Moon HG, Nam SJ, Lee JW, Lim W, et al. Survival improvement in Korean breast cancer patients due to increases in early-stage cancers and hormone receptor positive/HER2 negative subtypes: a nationwide registry-based study. J Breast Cancer. 2015; 18:8–15. PMID: 25834605.
Article
9. Dawood S, Broglio K, Gonzalez-Angulo AM, Buzdar AU, Hortobagyi GN, Giordano SH. Trends in survival over the past two decades among white and black patients with newly diagnosed stage IV breast cancer. J Clin Oncol. 2008; 26:4891–4898. PMID: 18725649.
Article
10. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 365:1687–1717. PMID: 15894097.
11. Trudeau M, Charbonneau F, Gelmon K, Laing K, Latreille J, Mackey J, et al. Selection of adjuvant chemotherapy for treatment of node-positive breast cancer. Lancet Oncol. 2005; 6:886–898. PMID: 16257797.
Article
12. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005; 353:1659–1672. PMID: 16236737.
13. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, et al. SEER cancer statistics review, 1975–2010. National Cancer Institute: Accessed Apr 11th, 2017. http://seer.cancer.gov/csr/1975_2010.
14. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2014. Sejong: Ministry of Health and Welfare;2016. p. 36.
15. Min SY, Kim Z, Hur MH, Yoon CS, Park EH, Jung KW, et al. The basic facts of Korean breast cancer in 2013: results of a nationwide survey and breast cancer registry database. J Breast Cancer. 2016; 19:1–7. PMID: 27066090.
Article
16. Goldhirsch A, Gelber RD, Coates AS. What are the long-term effects of chemotherapy and hormonal therapy for early breast cancer? Nat Clin Pract Oncol. 2005; 2:440–441. PMID: 16265010.
Article
17. Henderson IC, Berry DA, Demetri GD, Cirrincione CT, Goldstein LJ, Martino S, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol. 2003; 21:976–983. PMID: 12637460.
Article
18. Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science. 1987; 235:177–182. PMID: 3798106.
19. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383:2127–2135. PMID: 24656685.
20. Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999; 17:1689–1700. PMID: 10561205.
Article
21. Taghian A, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol. 2004; 22:4247–4254. PMID: 15452182.
Article
22. Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol. 2007; 82:247–253. PMID: 17306393.
23. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015; 373:317–327. PMID: 26200978.
Article
24. Krug D. Regional nodal irradiation in early-stage breast cancer with 0-3 positive nodes. Strahlenther Onkol. 2015; 191:889–891. PMID: 26374451.
Full Text Links
  • JBC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr