Introduction
Materials and Methods
Cohort Selection
Surgical Cohorts
Treatment Recommendations from the Norwegian Breast Cancer Group Between 1998 and 2008
Statistical Analyses
Results
Surgical main cohorts | Surgical sub cohorts | ||||||||
---|---|---|---|---|---|---|---|---|---|
Number 13,015 | Reoperateda
| Number 13,015 | |||||||
PrimaryBCT | PrimaryMTX | BCT | MTX | BCTonce | BCTreop. | BCT-MTX | MTX once | MTX reop. | |
Number of patients | 8065 | 4950 | 1481 | 164 | 6583 | 1287 | 194 | 4786 | 164 |
Proportion of patients | 62 | 38 | 50.6 | 9.9 | 1.5 | 36.7 | 1.3 | ||
Median follow-up time | 7.3 years | 7.0 years | 7.3 years | 7.5 years | 8.7 years | 7.0 years | 7.0 years | ||
Proportion RT | 99.3 | 30.7 | 100 | 100 | 70.1 | 30.3 | 43.3 |
Year of diagnosis | Annual proportion (100 %) | Reoperateda
| Annual proportion (100 %) | ||||||
---|---|---|---|---|---|---|---|---|---|
BCT | MTX | ||||||||
1998 | 34 % (264) | 66 % (512) | 16 % | 3.3 % | 29 % | 3.1 % | 2.2 % | 63.8 % | 2.2 % |
1999 | 35 % (279) | 65 % (520) | 18 % | 6.3 % | 29 % | 3.9 % | 2.4 % | 61.0 % | 4.1 % |
2000 | 41 % (364) | 59 % (519) | 14 % | 3.5 % | 35 % | 4.0 % | 1.8 % | 56.7 % | 2.0 % |
2001 | 53 % (482) | 47 % (422) | 21 % | 4.3 % | 42 % | 9.2 % | 1.9 % | 44.7 % | 2.0 % |
2002 | 63 % (736) | 37 % (436) | 23 % | 3.9 % | 49 % | 11.9 % | 2.2 % | 35.8 % | 1.5 % |
2003 | 72 % (967) | 28 % (384) | 23 % | 3.6 % | 55 % | 14.9 % | 1.6 % | 27.4 % | 1.0 % |
2004 | 73 % (1005) | 26 % (368) | 20 % | 2.2 % | 58 % | 13.9 % | 1.0 % | 26.2 % | 0.6 % |
2005 | 72 % (1042) | 28 % (407) | 17 % | 2.7 % | 60 % | 10.8 % | 1.2 % | 27.3 % | 0.8 % |
2006 | 71 % (962) | 29 % (388) | 18 % | 2.8 % | 59 % | 11.0 % | 1.6 % | 27.9 % | 0.8 % |
2007 | 68 % (990) | 32 % (465) | 17 % | 1.3 % | 57 % | 10.5 % | 0.9 % | 31.5 % | 0.4 % |
2008 | 65 % (974) | 35 % (529) | 14 % | 2.1 % | 56 % | 8.3 % | 0.9 % | 34.5 % | 0.7 % |
Age at diagnosis (years) | |||||||||
<30 | 61 % (31) | 39 % (20) | 26 % | 5.0 % | 45 % | 16 % | 0 % | 37 % | 2.0 % |
30–39 | 56 % (287) | 44 % (222) | 26 % | 5.0 % | 42 % | 11 % | 3.9 % | 41 % | 2.2 % |
40–49 | 66 % (1467) | 34 % (761) | 20 % | 4.5 % | 53 % | 11 % | 2.1 % | 33 % | 1.5 % |
50–59 | 72 % (3024) | 29 % (1203) | 19 % | 3.7 % | 58 % | 12 % | 1.5 % | 27 % | 1.0 % |
60–69 | 72 % (2515) | 29 % (1024) | 17 % | 2.5 % | 59 % | 11 % | 1.1 % | 28 % | 0.7 % |
70–79 | 38 % (651) | 62 % (1062) | 16 % | 2.9 % | 32 % | 5 % | 1.3 % | 60 % | 1.8 % |
≥80 | 12 % (90) | 88 % (658) | 13 % | 2.6 % | 10 % | 1 % | 0.5 % | 86 % | 2.3 % |
TNM stage | |||||||||
T1N0 | 75 % (5165) | 25 % (1686) | 17 % | 2.4 % | 63 % | 11 % | 1.7 % | 24 % | 0.6 % |
T2N0 | 44 % (888) | 56 % (1140) | 20 % | 2.4 % | 35 % | 8 % | 1.2 % | 55 % | 1.3 % |
T1N1 | 60 % (1340) | 40 % (893) | 22 % | 4.4 % | 47 % | 11 % | 2.0 % | 38 % | 1.7 % |
T2N1 | 35 % (672) | 65 % (1231) | 20 % | 4.6 % | 28 % | 7 % | 0.5 % | 62 % | 3.0 % |
Histology | |||||||||
Ductal c. | 62 % (6618) | 38 % (3981) | 18 % | 3.5 % | 51 % | 10 % | 1.5 % | 36 % | 1.3 % |
Lobular c. | 58 % (756) | 42 % (549) | 24 % | 2.6 % | 44 % | 12 % | 2.0 % | 41 % | 1.1 % |
Other c. | 62 % (691) | 38 % (420) | 19 % | 2.6 % | 51 % | 10 % | 1.3 % | 37 % | 1.0 % |
Grade | |||||||||
I | 73 % (2261) | 27 % (844) | 16 % | 2.7 % | 61 % | 11 % | 1.1 % | 26 % | 0.7 % |
II | 61 % (3600) | 39 % (2259) | 17 % | 3.3 % | 51 % | 9 % | 1.3 % | 37 % | 1.3 % |
III | 54 % (1650) | 46 % (1382) | 23 % | 4.1 % | 42 % | 10 % | 2.3 % | 44 % | 1.8 % |
Unknown | 54 % (554) | 46 % (465) | 22 % | 2.4 % | 42 % | 10 % | 1.7 % | 45 % | 1.1 % |
Impact of Surgery Type on Overall and Breast Cancer-Specific Survival
Median age | Total number at start | Number of overall deaths in 5-year period | Overall survival | Number of breast cancer deaths | Breast cancer survival | |
---|---|---|---|---|---|---|
Survival | ||||||
5-year | 59.0 | 13,015 | 1334 | 89 % | 742 | 94 % |
10-year | 59.0 | 9814 | 2260 | 78 % | 1083 | 89 % |
Surgical main cohorts | ||||||
5-year survival BCT | 56.9 | 8065 | 412 | 95 % | 225 | 97 % |
5-year survival MTX | 62.4 | 4950 | 922 | 80 % | 517 | 88 % |
10-year survival BCT | 56.9 | 6370 | 796 | 86 % | 384 | 93 % |
10-year survival MTX | 62.4 | 3444 | 1464 | 64 % | 699 | 82 % |
Age < 50 years | ||||||
5-year survival BCT | 43.6 | 1785 | 89 | 95 % | 72 | 96 % |
5-year survival MTX | 42.7 | 1003 | 120 | 87 % | 111 | 88 % |
Age 50–69 years | ||||||
5-year survival BCT | 58.8 | 5539 | 232 | 95 % | 115 | 98 % |
5-year survival MTX | 59.0 | 2227 | 296 | 86 % | 201 | 90 % |
Age ≥ 70 years | ||||||
5-year survival BCT | 74.6 | 741 | 91 | 87 % | 38 | 94 % |
5-year survival MTX | 78.3 | 1720 | 506 | 69 % | 205 | 86 % |
Surgical subcohorts, 5-year survival | ||||||
BCT operated once | 57.0 | 6583 | 324 | 95 % | 163 | 97 % |
BCT with reoperation | 56.2 | 1287 | 67 | 94 % | 48 | 96 % |
BCT followed by MTX | 55.2 | 195 | 21 | 89 % | 14 | 92 % |
MTX operated once | 62.5 | 4786 | 884 | 80 % | 484 | 89 % |
MTX with reoperation | 59.3 | 164 | 38 | 76 % | 33 | 79 % |
Crude | Adjusted | |||||||
---|---|---|---|---|---|---|---|---|
Overall death | Breast cancer death | Overall death | Breast cancer death | |||||
HR | 95 % CI | HR | 95 % CI | HR | 95 % CI | HR | 95 % CI | |
Surgical main cohorts | ||||||||
Primary BCT | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
Primary MTX | 3.11 | (2.86–3.38) | 3.16 | 2.79–3.57 | 1.65 | 1.50–1.82 | 1.64 | 1.43–1.88 |
Surgical subcohorts | ||||||||
BCT once | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
BCT reop. | 1.05 | 0.87–1.26 | 1.38 | 1.07–1.77 | 1.04 | 0.86–1.25 | 1.28 | 0.99–1.64 |
BCT-MTX | 1.90 | 1.39–2.58 | 2.92 | 1.97–4.33 | 1.69 | 1.24–2.31 | 2.19 | 1.47–3.26 |
MTX once | 3.90 | 2.89–3.47 | 3.35 | 2.92–3.85 | 1.68 | 1.51–1.86 | 1.72 | 1.48–2.01 |
MTX reop. | 4.56 | 3.60–5.78 | 7.93 | 5.94–10.58 | 2.50 | 1.96–3.19 | 3.40 | 2.53–4.58 |
Year of diagnosis | ||||||||
1998 | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
1999 |
0.93
| 0.79 |
0.89
| 0.73 | ||||
2000 |
0.87
| 0.78 |
0.9
| 0.77 | ||||
2001 |
0.87
| 0.75 |
1.05
|
0.83
| ||||
2002 | 0.69 | 0.53 |
0.89
| 0.63 | ||||
2003 | 0.77 | 0.58 |
0.99
| 0.76 | ||||
2004 | 0.64 | 0.45 |
0.89
| 0.62 | ||||
2005 | 0.69 | 0.34 |
0.87
| 0.44 | ||||
2006 | 0.6 | 0.29 | 0.75 | 0.39 | ||||
2007 | 0.59 | 0.22 | 0.77 | 0.30 | ||||
2008 | 0.53 | 0.17 | 0.66 | 0.23 | ||||
Age categories (years) | ||||||||
<30 | 2.15 | 3.12 |
1.51
|
1.78
| ||||
30–39 | 1.59 | 2.42 |
1.15
| 1.46 | ||||
40–49 |
0.98
| 1.21 | 0.82 |
0.91
| ||||
50–59 | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
60–69 | 1.42 |
0.96
| 1.52 |
1.11
| ||||
70–79 | 3.71 | 2.15 | 2.98 | 1.66 | ||||
≥80 | 8.38 | 2.92 | 6.04 | 2.13 | ||||
TNM stage | ||||||||
T1N0M0 | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
T2N0M0 | 2.38 | 2.95 | 1.41 | 1.83 | ||||
T1N1M0 | 1.56 | 2.86 | 1.92 | 2.18 | ||||
T2N1M0 | 3.34 | 6.57 | 3.37 | 3.95 | ||||
Histology | ||||||||
Ductal c. | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
Lobular c. |
1.04
|
0.88
|
0.93
|
0.91
| ||||
Other |
1.03
|
0.89
|
1.04
|
1.02
| ||||
Grade | ||||||||
I | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) | 1.00 | (Reference) |
II | 1.69 | 2.61 | 1.41 | 1.98 | ||||
III | 2.47 | 5.65 | 1.92 | 3.53 | ||||
Unknown | 1.73 | 2.84 | 1.30 | 1.99 |
Crude | Adjusted | ||||
---|---|---|---|---|---|
Overall death | Breast cancer death | Overall death | Breast cancer death | ||
HR | HR | HR | HR | ||
Women aged < 50 years
| |||||
Surgery | Nr | ||||
Primary BCT | 1785 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Primary MTX | 1003 | 2.10 (1.71–2.59) | 2.51 (1.98–3.18) | 1.43 (1.15–1.80) | 1.58 (1.22–2.04) |
Surgical subcohorts | |||||
BCT once | 1415 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
BCT reop. | 304 | 0.88 (0.57–1.35) | 0.84 (0.50–1.41) | 0.85 (0.54–1.31) |
0.80 (0.48–1.35)
|
BCT-MTX | 66 | 1.51 (0.79–2.87) | 1.50 (0.70–3.23) | 1.45 (0.75–2.79) | 1.32 (0.60–2.87) |
MTX once | 957 | 1.96 (1.56–2.46) | 2.32 (1.79–3.01) | 1.35 (1.06–1.72) | 1.46 (1.11–1.93) |
MTX reop. | 46 | 5.42 (3.42–8.61) | 6.41 (3.87–10.62) | 2.95 (1.83–4.75) | 3.12 (1.86–5.25) |
Women aged 50–69 years
| |||||
Surgery type | |||||
Primary BCT | 5539 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Primary MTX | 2227 | 2.40 (2.12–2.72) | 3.26 (2.74–3.88) | 1.74 (1.52–2.00) | 1.64 (1.35–1.99) |
Surgical subcohorts | |||||
BCT once | 4546 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
BCT reop. | 891 | 1.14 (0.90–1.43) | 1.83 (1.34–2.49) | 1.09 (0.87–1.39) | 1.71 (1.25–2.33) |
BCT-MTX | 102 | 2.24 (1.47–3.40) | 3.95 (2.32–6.71) | 2.03 (1.33–3.09) | 2.91 (1.70–6.28) |
MTX once | 2157 | 2.42 (2.13–2.78) | 3.65 (3.99–4.45) | 1.77 (1.35–2.05) | 1.85 (1.49–2.30) |
MTX reop. | 70 | 5.35 (3.77–7.59) | 11.70 (7.77–17.62) | 3.32 (2.31–4.78) | 4.09 (2.66–6.28) |
Women aged ≥ 70 years
| |||||
Surgery type | |||||
Primary BCT | 741 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Primary MTX | 1720 | 2.15 (1.84–2.51) | 2.23 (1.67–2.96) | 1.56 (1.31–1.85) | 1.50 (1.10–2.05) |
Surgical subcohorts | |||||
BCT once | 622 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
BCT reop. | 92 |
1.16 (0.77–1.76)
|
1.05 (0.47–2.32)
|
1.01 (0.72–1.66)
|
0.83 (0.34–1.84)
|
BCT MTX | 27 |
1.42 (0.75–2.69)
|
2.68 (1.06–6.76)
|
1.30 (0.68–2.47)
|
1.92 (0.75–4.90)
|
MTX once | 1672 | 2.25 (1.89–2.67) | 2.36 (1.72–3.23) | 1.61 (1.33–1.93) | 1.52 (1.08–2.13) |
MTX reop. | 48 | 1.67 (1.06–2.64) | 2.82 (1.43–5.62) |
1.36 (0.85–2.16)
| 2.14 (1.06–4.31) |
T1N0M0 grade 1
| |||||
Surgery type | |||||
Primary BCT | 1451 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Primary MTX | 366 | 2.61 (1.91–3.56) | 3.52 (1.80–6.90) | 1.77 (1.22–2.56) | 2.07 (0.94–4.56) |
Surgical sub cohorts | |||||
BCT once | 1245 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
MTX once | 358 | 2.61 (1.88–3.61) | 4.73 (2.22–10.10) | 1.80 (1.23–2.63) | 2.80 (1.18–6.61) |