Improved survival for women with stage I breast cancer in south-east Sweden: A comparison between two time periods before and after increased use of adjuvant systemic therapy

Figures & data

Table Ia.  Breast cancer stage I. Recommendations for postoperative adjuvant systemic therapy according to the management programme of 1983.

Patient age	Hormonal receptors	S-phase fraction	Tumour size	Systemic therapy
<50 years	Positive	All	All	None
	Negative	All	All	None
≥50 years	Positive	All	11–20 mm	Hormonal
	Negative	All	All	None

Table Ib.  Breast cancer stage I. Recommendations for postoperative adjuvant systemic therapy according to the management programme of 1992.

Patient age	Hormonal receptors	S-phase fraction	Tumour size	Systemic therapy
< 50 years	Positive	≥ 10%	11–20 mm	Hormonal
	Negative/Unknown	≥ 10%	11–20 mm	Cytotoxic
≥ 50 years^1	Positive	All	11–20 mm	Hormonal
	Negative/Unknown	All	All	None

¹The recommendations used for patients under 50 years of age could also be applied in the age group 50–60 years.

Table II.  Patient and tumour data in the two cohorts, also divided by age

		Period 1 (1986–1991)				Period 2 (1992–1999)
		<50 years		50–59 years		<50 years		50–59 years
Category	Group	N	%	N	%	N	%	N	%
	All patients	271	52.2	248	47.8	365	41.1	523	58.9
Tumour size	≤10 mm	102	38.2	94	38.4	140	39.1	202	39.1
	11–20 mm	165	61.8	151	61.6	218	60.9	315	60.9
	unknown	4		3		7		6
Median tumour size (mm)		12		12		12		12
Receptor status	Positive	140	75.3	135	77.6	205	81.7	261	80.6
	Negative	46	24.7	39	22.4	46	18.3	63	19.4
	unknown	85		74		114		199
S-phase fraction	Low	93	75.0	94	75.2	140	71.4	191	74.6
	High	31	25.0	31	24.8	56	28.6	65	25.4
	unknown	147		123		169		267
Surgical method	Mastectomy	109	40.1	114	46.2	126	34.6	141	27.0
	Breast-conserving	162	59.9	134	53.8	239	65.4	382	73.0
Adjuvant therapy	Radiotherapy	163	62.2	149	61.3	254	73.0	391	80.0
	Hormonal	24	8.9	127	51.2	90	24.7	227	43.4
	Cytotoxic	3	1.1	–	–	26	7.1	14	2.7
	None	101	37.3	46	18.5	77	21.1	63	12.0
Ten year follow-up	Dist. recurrence	42	15.5	32	12.9	38	10.4	44	8.4
	Mortality	40	14.8	36	14.5	30	8.2	60	11.5

Table III.  Frequency of adjuvant systemic treatment in Period 1 and 2, divided by receptor status and S-phase fraction.

		Period 1 (1986–1991)			Period 2 (1992–1999)
Receptor status	S-phase fraction	N	Hormonal therapy %	Cytotoxic therapy %	N	Hormonal therapy %	Cytotoxic therapy %
Positive	Low	161	44.7	–	282	46.8	1.1
	High	38	39.5	2.6	74	70.3	10.8
	Unknown	76	47.4	–	110	44.5	1.8
Negative	Low	24	8.3	–	31	3.2	12.9
	High	24	20.8	4.2	47	12.8	36.2
	Unknown	37	10.8	–	31	16.1	9.7
Unknown	Low	2	–	–	18	27.8	–
	High	0	–	–	0	–	–
	Unknown	157	10.8	0.6	295	22.7	1.0
All	All	519	29.1	0.6	888	35.7	4.5

Figure 1.  Overall survival (A) and distant recurrence free survival (B) for all patients.

Table IV.  Five-year and ten-year distant recurrence free survival rates in Period 1 and 2, divided by tumour characteristics.

Category	Diagnosis period	5 years (CI 95%)	10 years (CI 95%)
All patients	Period 1	90.2 (±2.6)*	85.4 (±3.1)*
	Period 2	93.8 (±1.6)	90.0 (±2.1)
T ≤ 10 mm	Period 1	93.8 (±3.4)	89.6 (±4.2)
	Period 2	95.5 (±2.2)	93.5 (±2.7)
T11–20 mm	Period 1	87.8 (±3.6)*	82.5 (±4.2)*
	Period 2	92.5 (±2.3)	88.0 (±2.9)
Receptor positive	Period 1	91.5 (±3.3)	85.1 (±4.3)
	Period 2	92.7 (±2.4)	88.3 (±3.1)
Receptor negative	Period 1	79.9 (±8.6)	73.8 (±9.4)
	Period 2	87.0 (±6.4)	83.8 (±7.1)
Low S-phase fraction	Period 1	94.0 (±3.4)	87.8 (±4.8)
	Period 2	95.3 (±2.3)	90.4 (±3.4)
High S-phase fraction	Period 1	72.4 (±11.2)	62.2 (±12.2)*
	Period 2	80.7 (±7.1)	78.8 (±7.4)
Receptor positive, low S-phase	Period 1	94.3 (±3.6)	87.8 (±5.2)
	Period 2	96.0 (±2.3)	91.2 (±3.5)
Receptor positive, high S-phase	Period 1	73.3 (±14.2)	62.2 (±15.7)
	Period 2	78.2 (±9.5)	76.4 (±9.9)
Receptor negative, low S-phase	Period 1	91.5 (±11.3)	87.1 (±13.6)
	Period 2	87.1 (±11.8)	82.0 (±14.8)
Receptor negative, high S-phase	Period 1	70.8 (±18.2)	62.2 (±19.5)*
	Period 2	84.7 (±10.4)	82.4 (±11.1)

*log rank p-value < 0.05.

Figure 2.  Distant recurrence-free survival in relation to S-phase fraction for patients given no adjuvant systemic therapy.

Table V.  Multivariate analysis of distant recurrence rates with Cox proportional hazard method including diagnosis period, tumour characteristics, treatment and patient's age.

Category	Group	HR^1	CI 95%	P-value
Diagnosis period	Period 1	1.00	0.40–0.93	0.021
	Period 2	0.61
Tumour size	≤10 mm	1.00	0.87–2.41	0.15
	11–20 mm	1.45
Receptor status	Negative	1.00	0.62–1.88	0.80
	Positive	1.08
S-phase fraction	Low	1.00	1.73–4.13	<0.001
	High	2.67
Surgical method	Mastectomy	1.00	0.54–1.22	0.31
	Breast-conserving	0.81
Hormonal therapy	No	1.00	0.52–1.36	0.48
	Yes	0.84
Cytotoxic therapy	No	1.00	0.85–3.72	0.13
	Yes	1.77
Age	<50 years	1.00	0.65–1.58	0.96
	50–59 years	1.01

¹Distant recurrence rate ratio.

Figure 3.  Distant recurrence free survival for the two periods divided by tumour size.

Figure 4.  Distant recurrence free survival for the two periods divided by hormone receptor status and S-phase fraction. (A) Receptor positive patients. (B) Receptor negative patients.