Introduction
Methods
Database
Cancer registration in Bavaria
Inclusion and exclusion criteria
Analysis of HR
Quality assurance methods
Statistical analyses
Results
Analysis of patients’ characteristics
Year of diagnosis | Number of patients (n) | HR-status unknown (n, %) | HR-status analyzed (n, %) | HR-positive (n, %) | HR-negative (n, %) |
---|---|---|---|---|---|
2000 | 448 | 28 (6.3 %) | 420 (93.7 %) | 345 (82.1 %) | 75 (17.9 %) |
2001 | 472 | 16 (3.4 %) | 456 (96.6 %) | 401 (87.9 %) | 55 (12.1 %) |
2002 | 477 | 19 (4.0 %) | 458 (96.0 %) | 379 (82.8 %) | 79 (17.2 %) |
2003 | 536 | 10 (1.9 %) | 526 (98.1 %) | 466 (88.6 %) | 60 (11.4 %) |
2004 | 595 | 20 (3.4 %) | 575 (96.6 %) | 489 (85.0 %) | 86 (15.0 %) |
2005 | 585 | 8 (1.4 %) | 577 (98.6 %) | 471 (81.6 %) | 106 (18.4 %) |
2006 | 570 | 1 (0.2 %) | 569 (99.8 %) | 487 (85.6 %) | 82 (14.4 %) |
2007 | 603 | 34 (5.6 %) | 569 (94.4 %) | 492 (86.5 %) | 77 (13.5 %) |
2008 | 608 | 45 (7.4 %) | 563 (92.6 %) | 464 (82.4 %) | 99 (17.6 %) |
2009 | 721 | 3 (0.4 %) | 718 (99.6 %) | 624 (86.9 %) | 94 (13.1 %) |
2010 | 628 | 4 (0.6 %) | 624 (99.4 %) | 542 (86.9 %) | 82 (13.1 %) |
2011 | 579 | 2 (0.3 %) | 577 (99.7 %) | 513 (88.9 %) | 64 (11.1 %) |
2012 | 599 | 2 (0.3 %) | 597 (99.7 %) | 526 (88.1 %) | 71 (11.9 %) |
Total | 7421 | 192 (2.6 %) | 7229 (97.4 %) | 6199 (85.8 %) | 1030 (14.2 %) |
Parameter | HR-positive (n = 6199) | HR-negative (n = 1030) | Total (n = 7229) |
P valuea
|
---|---|---|---|---|
Age (year), mean ± SD | 62 ± 13 | 57 ± 14 | 61 ± 13 | <0.001 |
Menopausal state, n (%) | ||||
Premenopausal | 1369 (22.1 %) | 315 (30.6 %) | 1684 (23.3 %) | <0.001 |
Postmenopausal | 4830 (77.9 %) | 715 (69.4 %) | 5545 (76.7 %) | |
Histology, n (%) | ||||
Ductal | 4913 (79.3 %) | 896 (87.0 %) | 5809 (80.4 %) | <0.001 |
Lobular | 876 (14.1 %) | 28 (2.7 %) | 904 (12.5 %) | |
Other | 410 (6.6 %) | 106 (10.3 %) | 516 (7.1 %) | |
Tumor size, n (%) | ||||
pT0 | 27 (0.4 %) | 31 (3.0 %) | 58 (0.8 %) | <0.001 |
pT1 | 3385 (54.6 %) | 435 (42.2 %) | 3820 (52.8 %) | |
pT2 | 2217 (35.8 %) | 449 (43.6 %) | 2666 (36.9 %) | |
pT3 | 237 (3.8 %) | 49 (4.8 %) | 286 (4.0 %) | |
pT4 | 301 (4.9 %) | 56 (5.4 %) | 357 (4.9 %) | |
Unknown | 32 (0.5 %) | 10 (1.0 %) | 42 (0.6 %) | |
Nodal status, n (%) | ||||
pN0 | 3832 (61.8 %) | 608 (59.0 %) | 4440 (61.4 %) | 0.032 |
pN1 | 1534 (24.7 %) | 249 (24.2 %) | 1783 (24.7 %) | |
pN2 | 425 (6.9 %) | 93 (9.0 %) | 518 (7.2 %) | |
pN3 | 283 (4.6 %) | 57 (5.5 %) | 340 (4.7 %) | |
Unknown | 125 (2.0 %) | 23 (2.2 %) | 148 (2.0 %) | |
Grading, n (%) | ||||
G1 | 1017 (16.4 %) | 14 (1.4 %) | 1031 (14.3 %) | <0.001 |
G2 | 3891 (62.8 %) | 256 (24.9 %) | 4147 (57.4 %) | |
G3 | 1252 (20.2 %) | 752 (73.0 %) | 2004 (27.7 %) | |
Unknown | 39 (0.6 %) | 8 (0.8 %) | 47 (0.7 %) | |
HER2, n (%) | ||||
Negative | 4678 (75.5 %) | 624 (60.6 %) | 5302 (73.3 %) | <0.001 |
Positive | 952 (15.4 %) | 306 (29.7 %) | 1258 (17.4 %) | |
Unknown | 569 (9.2 %) | 100 (9.7 %) | 669 (9.3 %) | |
Lymphatic invasion, n (%) | ||||
Positive | 1676 (27.0 %) | 350 (34.0 %) | 2026 (28.0 %) | <0.001 |
Negative | 3024 (48.8 %) | 430 (41.7 %) | 3454 (47.8 %) | |
Unknown | 1499 (24.2 %) | 250 (24.3 %) | 1749 (24.2 %) | |
Vascular invasion, n (%) | ||||
Positive | 320 (5.2 %) | 92 (8.9 %) | 412 (5.7 %) | <0.001 |
Negative | 4168 (67.2 %) | 634 (61.6 %) | 4802 (66.4 %) | |
Unknown | 1711 (27.6 %) | 304 (29.5 %) | 2015 (27.9 %) |
Premenopausal (n = 1684, 23 %) | Postmenopausal (n = 5545, 77 %) | Total (n = 7229, 100 %) | |
---|---|---|---|
ER+PR+ | 1206 (71.6 %) | 4137 (74.6 %) | 5343 (73.9 %) |
ER+PR− | 125 (7.4 %) | 600 (10.8 %) | 725 (10.0 %) |
ER−PR+ | 38 (2.3 %) | 93 (1.7 %) | 131 (1.8 %) |
ER−PR− | 315 (18.7 %) | 715 (12.9 %) | 1030 (14.2 %) |
Distribution of HR-status across different pathologies
Systemic therapies in HR-positive patients
Premenopausal (n = 1369, 22.1 %) | Postmenopausal (n = 4830, 77.9 %) | Total (n = 6199, 100 %) | |
---|---|---|---|
CHT + ET + Trastuzumab | 115 (8.4 %) | 170 (3.5 %) | 285 (4.6 %) |
CHT + Trastuzumab | 14 (1.0 %) | 18 (0.4 %) | 32 (0.5 %) |
ET + Trastuzumab | 1 (0.1 %) | 15 (0.3 %) | 16 (0.3 %) |
CHT + ET | 716 (52.3 %) | 1255 (26.0 %) | 1971 (31.8 %) |
ET | 343 (25.1 %) | 2670 (55.3 %) | 3013 (48.6 %) |
CHT | 96 (7.0 %) | 172 (3.6 %) | 268 (4.3 %) |
No adjuvant therapy | 84 (6.1 %) | 530 (11.0 %) | 614 (9.9 %) |
Analysis of type of ET in HR-positive patients
Premenopausal (n = 1175, 22.2 %) | Postmenopausal (n = 4110, 77.8 %) | Total (n = 5285, 100 %) | |
---|---|---|---|
Unknown | 178 (15.1 %) | 603 (14.7 %) | 781 (14.8 %) |
Known | 997 (84.9 %) | 3507 (85.3 %) | 4504 (85.2 %) |
Tamoxifen | 666 (66.8 %) | 1770 (50.5 %) | 2436 (54.1 %) |
Tamoxifen + GnRH | 199 (20.0 %) | 14 (0.4 %) | 213 (4.7 %) |
Tamoxifen + AI | 14 (1.4 %) | 98 (2.8 %) | 112 (2.5 %) |
AI | 87 (8.7 %) | 1625 (46.3 %) | 1712 (38.0 %) |
GnRH | 31 (3.1 %) | – | 31 (0.7 %) |
Survival analyses in HR-positive patients
3-Year OS (%) | 5-Year OS (%) | 6-Year OS (%) | 7-Year OS (%) | |
---|---|---|---|---|
CHT + ET + Trastuzumab | ||||
Premenopausal (n = 115, 8.5 %) | 98.9 | 97.2 | 97.2 | 97.2 |
Postmenopausal (n = 170, 3.5 %) | 96.6 | 93.1 | 93.1 | 86.9 |
CHT + ET | ||||
Premenopausal (n = 716, 52.9 %) | 97.1 | 95.6 | 94.5 | 92.7 |
Postmenopausal (n = 1255, 26.2 %) | 95.9 | 89.9 | 87.0 | 84.5 |
ET | ||||
Premenopausal (n = 343, 25.3 %) | 99.0 | 96.9 | 96.5 | 95.3 |
Postmenopausal (n = 2670, 55.7 %) | 93.9 | 87.8 | 84.8 | 81.7 |
CHT | ||||
Premenopausal (n = 96, 7.1 %) | 92.7 | 83.7 | 77.6 | 77.6 |
Postmenopausal (n = 172, 3.6 %) | 80.5 | 75.9 | 74.9 | 72.4 |
No adjuvant therapy | ||||
Premenopausal (n = 84, 6.2 %) | 94.1 | 90.8 | 73.1 | 73.1 |
Postmenopausal (n = 530, 11.0 %) | 79.2 | 68.8 | 63.5 | 58.9 |
Survival effects as a function of menopausal state
Characteristic | Overall survival (n = 5410, events = 705) | ||
---|---|---|---|
HR | 95 % CI |
P value | |
Primary therapy | |||
CHT + ET + Trastuzumab | Reference | ||
CHT + ET | 1.68 | 0.89, 3.15 | 0.109 |
ET | 2.14 | 1.13, 4.06 | 0.019 |
CHT | 4.54 | 2.29, 9.00 | <0.001 |
No adjuvant therapy | 4.69 | 2.43, 9.06 | <0.001 |
Age (years) | 1.05 | 1.04, 1.06 | <0.001 |
Tumor size | |||
pT1 | Reference | ||
pT2 | 1.53 | 1.27, 1.84 | <0.001 |
pT3 | 2.06 | 1.49, 2.85 | <0.001 |
pT4 | 2.51 | 1.92, 3.27 | <0.001 |
Nodal status | |||
N0 | Reference | ||
N1 | 1.55 | 1.29, 1.87 | <0.001 |
N2 | 1.90 | 1.46, 2.48 | <0.001 |
N3 | 2.69 | 2.04, 3.55 | <0.001 |
Grading | |||
G1 | Reference | ||
G2 | 1.29 | 0.99, 1.68 | 0.063 |
G3 | 2.00 | 1.49, 2.68 | <0.001 |
HER2/neu | |||
Negative | Reference | ||
Positive | 1.00 | 0.81, 1.23 | 0.986 |
Menopausal status | |||
Premenopausal | Reference | ||
Postmenopausal | 0.67 | 0.48, 0.92 | 0.012 |