The University of Texas MD Anderson Cancer Center, Houston, TX
Sangeetha Meda Reddy , Arup Kumar Sinha , Limin Hsu , Carlos Hernando Barcenas , Vicente Valero
Background: We counsel our triple negative breast cancer (TNBC) patients that recurrence is highest in the first 5 years after diagnosis. There is limited data with extended follow-up on frequency, characteristics, and predictors of late events. Methods: The MD Anderson database was retrospectively queried for stage I-III TNBC survivors disease-free at 5 years. TNBC was defined as estrogen (ER) and progesterone (PR) receptors < 10% and HER-2/neu negative per previous guidelines. We collected demographic, tumor, treatment, and outcome data. Kaplan-Meier method was used to estimate yearly recurrence free survival (RFS), overall survival (OS), and recurrence free interval (RFI) as defined by STEEP criteria. RFI is time to recurrence without including death as an event. Cox proportional hazards model was used to assess effect of low hormone receptor positivity on outcomes. Results: 881 patients were disease free at 5 years from diagnosis with median follow-up of 8.2 years. Table 1 quantifies cumulative probabilities of surviving without event. 22 patients had late recurrences (27.3% local and 72.7% distant). Most common distant recurrence sites were lung (50%), bone (31.8%), distant lymph nodes (36.4%), liver (18.2%), and brain (13.6%). 16 of these patients died, at median time 1.2 years after recurrence. There were 58 total deaths, 29.3% attributed to breast cancer, 13.8% to other, and 56.9% cause unknown. 19 patients developed second primary breast cancers and were censored from further analysis. Low hormone receptor positivity (ER and/or PR 1-9% versus < 1%) conferred higher risk for late events on multivariate analysis (HR 1.95 for RFS, p = 0.03; HR 1.81 for OS, p = 0.12; HR 1.82, p = 0.26 for RFI). Conclusions: 5 year disease-free TNBC survivors have a low probability of recurring over the subsequent 5 years. 10-year RFI was 98%, RFS 91%, and OS 93%. Patients with low hormone receptor cancers were found to have higher risk of late events.
Year From Diagnosis | RFI | RFS | OS |
---|---|---|---|
5-6 | 0.99 | 0.97 | 0.98 |
6-7 | 0.98 | 0.96 | 0.98 |
7-8 | 0.98 | 0.94 | 0.97 |
8-9 | 0.98 | 0.92 | 0.95 |
9-10 | 0.98 | 0.91 | 0.93 |
10-12 | 0.98 | 0.90 | 0.92 |
12-15 | 0.95 | 0.82 | 0.87 |
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