Journal Article

Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics

Morikawa, Aki, Brown, Jacqueline, Method, Michael, Nelson, David R.

2022

Overview

To investigate breast cancer-specific mortality by early breast cancer (EBC; Stages I-IIIC) subtype; incidence of high-risk indicators for recurrence (defined in monarchE trial); and mortality risk difference by those who did/did not meet these criteria. Analyses included patients with initial EBC diagnosis between 2010-2015 from Surveillance, Epidemiology, and End Results (SEER) data (n = 342,149). Cox proportional hazards models and Kaplan-Meier estimates examined mortality among 228,031 patients, by subtype (hormone receptor [HR]-positive [+], human epidermal growth factor receptor-2 [HER2] negative [-]; triple negative [TNBC]; HR+, HER2+; HR-, HER2+). Incidence and mortality among patients who did/did not meet monarchE clinicopathological high-risk criteria were examined. Among patients with HR+, HER2- EBC, histologic Grade 3 (vs. Grade 1) was the most influential factor on mortality (hazard ratio, 3.61; 95%CI, 3.27, 3.98). Among patients with TNBC, ≥4 ipsilateral axillary positive nodes (vs. node negative) was the most influential factor on mortality (hazard ratio, 3.46; 95%CI, 2.87, 4.17). For patients with HR-, HER2+ or HR+, HER2+ EBC, tumor size ≥5 cm (vs. <1 cm) and ≥4 ipsilateral axillary positive nodes were the most influential factors on mortality. The 60-month mortality rate for the 12% of patients within the HR+, HER2- EBC group meeting monarchE clinicopathological high-risk criteria was 16.5%, versus 7.0% (Stage II-III and node positive) and 2.8% (Stage I or node negative) for those not meeting criteria. The 60-month mortality rate for patients with TNBC was 18.5%. Mortality risk and the relative importance of risk factors varied by subtype. monarchE clinicopathological high-risk criteria were associated with increased mortality risk among patients with HR+, HER2- EBC. Patients with HR+, HER2- EBC, and monarchE clinicopathological high-risk criteria experienced risk of mortality similar to patients with early TNBC. These data highlight a high unmet need in this select patient population who may benefit most from therapy escalation.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Biology and Life Sciences / Breast cancer / Breast Neoplasms - drug therapy / Breast Neoplasms - epidemiology / Breast Neoplasms - mortality / Breast Neoplasms - pathology / Breast Neoplasms, Male - drug therapy / Breast Neoplasms, Male - epidemiology / Breast Neoplasms, Male - mortality / Breast Neoplasms, Male - pathology / Cancer therapies / Care and treatment / Chemotherapy / Collaboration / Criteria / Cyclin-dependent kinases / Epidemiology / Epidermal growth factor / ErbB-2 protein / FDA approval / Female / Growth factors / Health hazards / Health risks / Health surveillance / Humans / Incidence / Kaplan-Meier Estimate / Male / Medical prognosis / Medicine and Health Sciences / Metastasis / Middle Aged / Mortality / Mortality risk / Neoplasm Recurrence, Local / Neoplasm Staging / Nodes / Patient outcomes / Patients / Population / Proportional Hazards Models / Receptor, ErbB-2 - metabolism / Receptors / Risk analysis / Risk Factors / Skin cancer / Statistical models / Triple Negative Breast Neoplasms - drug therapy / Triple Negative Breast Neoplasms - mortality / Triple Negative Breast Neoplasms - pathology / Tumors / Young Adult