Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors

<div><p>Purpose</p><p>Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment.</p><p>Methods</p><p>We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).</p><p>Results</p><p>We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6).</p><p>Conclusion</p><p>Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.</p></div

Demographic and clinical characteristics of breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).

<p>Demographic and clinical characteristics of breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).</p

Kaplan-Meier curves for (A) recurrence-free survival (RFS), (B) distant relapse-free survival (DRFS), and (C) overall survival (OS) for breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).

<p>Kaplan-Meier curves for (A) recurrence-free survival (RFS), (B) distant relapse-free survival (DRFS), and (C) overall survival (OS) for breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).</p

Survival and recurrence outcomes in breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).

<p>Survival and recurrence outcomes in breast cancer survivors who received their initial treatment at our institution (MDA-treated) or elsewhere (OTH-treated).</p

AR expression by IHC staining.

<p>Representative images of AR-positive (A) and AR-negative (B) tumors. Arrows: tumors; arrowhead, normal breast epithelium. Original magnifications, x100.</p

Representative images of CTC subtypes identified by the Epic Sciences CTC platform.

<p>Representative fluorescence microscopy images of subtypes of CTCs identified by the Epic Sciences CTC platform. Blood samples from patients with metastatic breast cancer were deposited on glass slides and stained with a cocktail of DAPI and antibodies against CK, CD45, and AR. After staining, CTCs were detected using a digital pathology algorithm and classified into CTC subtypes on the basis of marker expression profile into CK+ CTCs, CK- CTCs, CTC clusters, and apoptotic CTCs. The top panel shows an AR+CK+ CTC with AR expression localized in the nucleus.</p

Single-cell CNV analysis of CTCs.

<p>Seventy eight CTCs with various biomarker (AR, ER and HER2) positive and negative and 1 white blood cell (germline control) detected in the sample from patient 11 were sequenced and analyzed for the presence of CNVs. (A) Characteristics of CTCs sequenced for CNV analysis according to AR, ER, and HER2 expression. (B) Representative examples of the 3 different CNV patterns identified in patient #11. The bottom figure is the CNV profile of the WBC. (C) Incidences of the 3 CNV patterns in CTCs according to AR, ER, and HER2 expression.</p

Clinicopathological characteristics of the 12 Patients with AR+ CTCs.

<p>Clinicopathological characteristics of the 12 Patients with AR+ CTCs.</p