Clinical outcome of primary non‑metastatic breast cancer: A single institution experience.

ABSTRACT

BACKGROUND: We report on prognostic factors and long‑term survival of non‑metastatic breast cancer patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC) in Pakistan. MATERIALS AND METHODS: This retrospective cohort study is based on a review of 2829 pathologically confirmed non‑metastatic breast cancer patients managed from January 1995 to May 2009. Median age was 45 years. Stage at presentation Stage I (9%), stage II (59%), and stage III (32%). Infiltrating ductal carcinoma (92%) constituted the most prevalent histological subtype. Estrogen (ER), progesterone (PR) and Her2‑neu were positive in 49%, 50%, and 26%, respectively. A mastectomy was performed in 67% and conservative surgery in 33% of the patients. Post‑operative radiotherapy was delivered in 85% of the cases. Ninety percent of the patients received chemotherapy and mainly consisted of anthracycline‑based regimens + taxanes. Hormonal manipulation was done in ER/ PR positive patients. RESULTS: The 5‑ and 10‑year overall survival (OS) was 70% (95% confidence interval [CI] 68.2‑71.8%) and 54% (95%CI 51.2‑56.8%), while disease free survival (DFS) was 65% (95% CI 63‑67%) and 52% (95% CI 49.2‑54.8%), respectively. Recurrence following primary treatment was seen in 35% of the patients. On multivariate analysis T stage, number of axillary nodal involvement, tumor grade, ER status and family history, were found to be independent predictors for OS and DFS. CONCLUSIONS: Over 90% of non‑metastatic breast cancer patients present with stagesII and III disease and a significant proportion develop distant metastasis accounting for overall long‑term outcome inferior to developed countries. Efforts should be directed to raise the level of health awareness and screening programs to improve early detection in Pakistan.