J Breast Cancer.  2019 Jun;22(2):297-310. 10.4048/jbc.2019.22.e18.

Comparative Analysis of Outcomes and Clinicopathological Characteristics of Synchronous and Metachronous Contralateral Breast Cancer: A Study of the SEER Database

Affiliations
  • 1Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. qiwudanfeng@sina.com
  • 2Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.

Abstract

PURPOSE
Numerous previous studies have reported inconsistent results about the differences between synchronous contralateral breast cancer (sCBC) and metachronous contralateral breast cancer (mCBC). This study aimed to compare the clinical characteristics and outcomes between sCBC and mCBC and determine predictive factors for the survival of sCBC and mCBC patients.
METHODS
Using the Surveillance, Epidemiology, and End Results Program database, we identified sCBC or mCBC patients from 2000 to 2010. The Kaplan-Meier method and Cox proportional hazards regression analysis were used to analyze overall survival and breast cancer-specific survival (BCSS) rates of sCBCs and mCBCs, respectively.
RESULTS
Overall, 14,057 sCBC (n = 8,139, 57.9%) and mCBC (n = 5,918, 42.1%) patients were included. The first tumors of sCBC were more likely to have higher stage and more lymph and distant metastases, whereas those of mCBC were more often infiltrating ductal carcinoma (IDC), had localized stage, were estrogen receptor (ER) and progesterone receptor (PR) negative, and had less axillary nodal involvement. The second tumors of mCBC tended to be IDC and have higher grade, adverse stage, ER and PR-negativity; and more axillary nodal involvement, compared to the second tumors of sCBC. mCBC patients had significantly favorable 5-year BCSS but worse long-term BCSS compared with sCBC patients. Moreover, subgroup analysis revealed no significant difference of BCSS between sCBC and mCBC among patients aged 18-60 years. Multivariate analysis indicated that age, grade, and stage of 2 tumors; surgery for second tumor; and ER status of the second tumor were independent prognostic factors for BCSS of contralateral breast cancer (CBC).
CONCLUSION
The characteristics and outcomes of sCBCs and mCBCs were substantially different. sCBC and mCBC patients may have different prognosis, and the prognosis of CBC depends on the first and second tumors.

Keyword

Age of onset; Breast neoplasms; Prognosis; Risk factors

MeSH Terms

Age of Onset
Breast Neoplasms*
Breast*
Carcinoma, Ductal
Estrogens
Humans
Methods
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Receptors, Progesterone
Risk Factors
SEER Program
Estrogens
Receptors, Progesterone

Figure

  • Figure 1 Identification of sCBC and mCBC in the SEER-18 registry. sCBC = synchronous contralateral breast cancer; mCBC = metachronous contralateral breast cancer; SEER = Surveillance, Epidemiology, and End Results.

  • Figure 2 BCSS and OS curves of sCBC and mCBC. (A) Kaplan-Meier curves for BCSS of sCBC and mCBC. (B) Kaplan-Meier curves for OS of sCBC and mCBC. The p < 0.05 was considered statistically significant. BCSS = breast cancer-specific survival; OS = overall survival; sCBC = synchronous contralateral breast cancer; mCBC = metachronous contralateral breast cancer.

  • Figure 3 Kaplan-Meier survival curves of sCBC and mCBC patients grouped by age between 2000 and 2010. (A) 18–39 age group; (B) 40–49 age group; (C) 50–59 age group; (D) 60–69 age group; (E) 70–79 age group; and (F) 80–88 age group. The p < 0.05 was considered statistically significant. BCSS = breast cancer-specific survival; sCBC = synchronous contralateral breast cancer; mCBC = metachronous contralateral breast cancer.

  • Figure 4 Survival curves of sCBC and mCBC patients of different age groups between 2000 and 2010. (A) Kaplan-Meier curves for BCSS of different age groups in sCBC patients. (B) Kaplan-Meier curves for BCSS of different age groups in mCBC patients. The p < 0.05 was considered statistically significant. BCSS = breast cancer-specific survival; sCBC = synchronous contralateral breast cancer; mCBC = metachronous contralateral breast cancer.


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