title: Survival after locoregional recurrence or second primary breast cancer: impact of the disease-free interval.
abstract: The association between the disease-free interval (DFI) and survival after a locoregional recurrence (LRR) or second primary (SP) breast cancer remains uncertain. The objective of this study is to clarify this association to obtain more information on expected prognosis. Women first diagnosed with early breast cancer between 2003-2006 were selected from the Netherlands Cancer Registry. LRRs and SP tumours within five years of first diagnosis were examined. The five-year period was subsequently divided into three equal intervals. Prognostic significance of the DFI on survival after a LRR or SP tumour was determined using Kaplan-Meier estimates and multivariable Cox regression analysis. Follow-up was complete until January 1, 2014. A total of 37,278 women was included in the analysis. LRRs or SP tumours were diagnosed in 890 (2,4%) and 897 (2,4%) respectively. Longer DFI was strongly and independently related to an improved survival after a LRR (long versus short: HR 0.65, 95% CI 0.48-0.88; medium versus short HR 0.81, 95% CI 0.65-1.01). Other factors related to improved survival after LRR were younger age (<70 years) and surgical removal of the recurrence. No significant association was found between DFI and survival after SP tumours. This is the first study to explore the association between the DFI and survival after recurrence in a nationwide population-based cancer registry. The DFI before a LRR is an independent prognostic factor for survival, with a longer DFI predicting better prognosis.
authors: Department of Health Technology and Services Research, MIRA Institute of Biomedical Technology and Technical Medicine, Twente University, Enschede, The Netherlands.
authors: Annemieke
authors: A
authors: Witteveen
authors: Department of Registration and Research, Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, the Netherlands.
authors: Annemiek B G
authors: AB
authors: Kwast
authors: Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
authors: Gabe S
authors: GS
authors: Sonke
authors: Department of Health Technology and Services Research, MIRA Institute of Biomedical Technology and Technical Medicine, Twente University, Enschede, The Netherlands.
authors: Maarten J
authors: MJ
authors: IJzerman
authors: Department of Health Technology and Services Research, MIRA Institute of Biomedical Technology and Technical Medicine, Twente University, Enschede, The Netherlands; Department of Registration and Research, Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, the Netherlands.
authors: Sabine
authors: S
authors: Siesling
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models