title: Survival of de novo stage IV breast cancer patients over three decades.
abstract: BACKGROUND
  De novo stage IV breast cancer patients (BCIV) depict a clinical picture not influenced by adjuvant therapy. Therefore, the time-dependent impact of changes in diagnostics and treatments on progression and survival can best be evaluated in this subgroup.
  
  
  METHODS
  BCIVpatients from 1978 to 2013 registered in the Munich Cancer Registry were divided into four periods, and the trends were analysed. Survival was estimated by Kaplan-Meier methods, and prognostic factors were fitted with Cox proportional hazard models.
  
  
  RESULTS
  Between 1978 and 2013, 88,759 patients were diagnosed with 92,807 cases of invasive and non-invasive BC. Of these patients, 4756 patients had distant metastases (MET) at diagnosis. The 5-year survival rate improved from 17.4 to 24.7%, while the pattern of metastases did not change. Improved staging diagnostics, a screening programme and primary systemic therapy changed the composition of prognostic strata. Patients with a similar composition as the 1978-1987 cohort exhibited a median survival difference of 13 months; however, neither univariate nor multivariate analysis showed a survival effect for the four periods as a surrogate indicator for changing treatments. HER2+ patients have with 27.6 months a slightly longer survival than all other BCIVpatients.
  
  
  CONCLUSIONS
  Survival of de novo BCIVhas only modestly improved since the late 1970s, partially masked by changing distributions of prognostic factors due to changes in diagnostics.
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hölzel
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Eckel
authors.affiliation: Head of the Breast Cancer Project Group of the Munich Tumour Centre (TZM) and of Department of Obstetrics and Gynaecology, Klinikum Landshut, Landshut, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Bauerfeind
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Baier
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum Rosenheim, Rosenheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beck
authors.affiliation: Department of Gynaecology, Rotkreuzklinikum, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Braun
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ettl
authors.affiliation: Department of Gynaecology, Rotkreuzklinikum, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hamann
authors.affiliation: Breast Center, Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Kiechle
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum Traunstein, Traunstein, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindlbeck
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: de Waal
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany. engel@ibe.med.uni-muenchen.de.
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
keywords: Breast cancer; Metastasis organs; Stage IV; Survival; Trends