Defining the survival benchmark for breast cancer patients with systemic relapse.
BACKGROUND
Our original paper, published in 1992, reported a median overall survival after first relapse in breast cancer of 26 months. The current retrospective review concentrates more specifically on patients with first systemic relapse, recognizing that subsets of patients with local recurrence are potentially curable.


METHODS
Records of 5,168 patients from a largely breast-cancer-specific oncology practice were reviewed to identify breast cancer patients with their first relapse between 1996 and 2006 after primary treatment. There were 189 patients diagnosed with metastatic disease within 2 months of being seen by our therapeutic team and 101 patients diagnosed with metastatic disease greater than 2 months. The patients were divided in order to account for lead-time bias than could potentially confound the analysis of the latter 101 patients.


RESULTS
Median survival for our primary study population of 189 patients was 33 months. As expected, the median survival from first systemic relapse (MSFSR) for the 101 patients excluded because of the potential for lead-time bias was better at 46 months. Factors influencing prognosis included estrogen receptor (ER) status, disease-free interval (DFI), and dominant site of metastasis. Compared with our original series, even with elimination of local-regional recurrences in our present series, the median survival from first relapse has improved by 7 months over the past two decades.


CONCLUSIONS
The new benchmark for MSFSR approaches 3 years.
Department of Hematology and Oncology, Emory Winship Cancer Institute, Atlanta, GA, USA.
Simon B
SB
Zeichner
Department of Hematology and Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Tadeu
T
Ambros
Department of Medicine, SUNY Downstate Medical Center, New York, NY, USA.
John
J
Zaravinos
Department of Solid Tumor Oncology, Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, OH, USA.
Alberto J
AJ
Montero
Department of Hematology and Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Boca Raton, FL, USA.
Reshma L
RL
Mahtani
Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL, USA.
Eugene R
ER
Ahn
Memorial Breast Cancer Center, Memorial Healthcare System, Pembroke Pines, FL, USA.
Aruna
A
Mani
Director of Advanced Analytics, RxAnte, LLC, Arlington, VA, USA.
Nathan J
NJ
Markward
Department of Hematology and Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Boca Raton, FL, USA.
Charles L
CL
Vogel
HER2 positive; breast cancer; disease-free interval; estrogen receptor positive; median survival; metastatic breast cancer; systemic relapse