Abstract P3-13-05: Change in survival of stage III and IV breast cancer patients from an institutional cohort: 1990-2007
Authors: Kaplan Henry G , Malmgren Judith A , Atwood Mary K 
Published: May 2015

Abstract
Background: Breast cancer (BC) survival has significantly improved over the last twenty years. Our investigation compares change in BC survival over time for patients presenting with Stage III and IV disease to evaluate the impact of treatment changes during this time period.
Methods: We examined breast cancer specific survival among a cohort of stage III and IV breast cancer patients age 40-64 years, identified and tracked for mortality from 1990-2007 at our institution (n=710). Patients were all biopsy proven BC with diagnosis, treatment and follow up recorded and tracked in our breast cancer specific registry database. Breast cancer staging was converted to AJCC 7 to remove inconsistency over time. Pearson chi square tests were used for bivariate comparisons. Kaplan Meier method was used for survival analysis with breast cancer death as the outcome for disease specific survival (DSS) and the log rank test for survival comparisons.
Results: Mean age of patients was 51.32 years with 85% stage III (n=603) and 15% stage IV (n=107). The percentage of stage IV patients presenting at our institution did not change over time (p = .197). Stage IV patients were less likely than stage III patients to have surgery, receive radiation or adjuvant chemotherapy (all p&lt;.001) (table). Stage IV patients that did receive systemic therapy were less likely to receive taxane therapy (p = .005) and were more likely to receive non-anthracyline regimens (p = .001) (table). There was no difference in hormone therapy given for the two groups. Five year disease specific survival (DSS) for all years combined was 79% for stage III vs. 51% for stage IV [10 year DSS stage III = 62%, stage IV = 24%] (p&lt;.001). When stratified by diagnosis year, stage III patients had significant change over time for 5 and 10 year disease free survival with a 13% improvement for 5 year DSS and 9% improvement for 10 year DSS over the 17 year time period [5 year DSS: 1990-94 = 71%, 1995-99 = 78%, 2000-07 = 84%; 10 year DSS: 1990-94 = 56%, 1995-99 = 60%, 2000-07 = 65% (p = .037). No change was observed over time for stage IV breast cancer [5 year DSS: 1990-94 = 50%, 1995-99 = 46%, 2000-07 = 52%; 10 year DSS: 1990-94 = 17%, 1995-99 = 33%, 2000-07 = 20% (p = .461)].
Conclusions: The significant improvement in stage III survival is most likely related to treatment improvements for breast cancer in the studied time period. The lack of improvement in survival for stage IV patients may be due to a biologic change in the nature of metastatic tumors that impacts response to treatment or possibly the less aggressive use of systemic therapy in stage IV relative to stage III patients.
Treatment Characteristics stage III and IV Breast Cancer (n=710)Stage IIIStage IVvariablesN (%)N (%)p valuechemotherapy = no14 (2%)27 (25%)&lt;.001radiation = no59 (10%)59 (55%)&lt;.001surgery = no1 (.2%)52 (49%)&lt;.001taxanes = no270 (46%)50 (63%).005non-anthracycline regimen108 (18%)27 (34%).001hormone therapy = yes397 (66%)70 (65%).933
Citation Format: Henry G Kaplan, Judith A Malmgren, Mary K Atwood. Change in survival of stage III and IV breast cancer patients from an institutional cohort: 1990-2007 [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-13-05.