Anti‐estrogen treatment of postmenopausal breast cancer patients with high risk of recurrence: 72 months of life‐table analysis and steroid hormone receptor status

• Published in: World journal of surgery 1985-10, Vol.9 (5), p.765-774
• Main Authors: Rose, Carsten, Mouridsen, Henning T., Thorpe, Susan M., Andersen, Johan, Blichert‐Toft, Mogens, Andersen, Knud W.
• Format: Article
• Language: English
• Subjects: Aged; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - surgery; Combined Modality Therapy; Early Recurrent Disease; Estrogen Receptor Concentration; Estrogen Receptor Content; Female; Humans; Menopause; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - prevention & control; Postmenopausal Breast Cancer Patient; Random Allocation; Receptors, Steroid - physiology; Steroid Hormone Receptor Status; Tamoxifen - therapeutic use
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01655192

The role of anti‐estrogen treatment of postmenopausal breast cancer patients with high risk of recurrent disease is evaluated in a nationwide, prospective, randomized trial conducted by the Danish Breast Cancer Group. After total mastectomy and postoperative radiotherapy, 829 patients were randomized to treatment with tamoxifen (RT + TAM) for 1 year and 821 were randomized to no further therapy (RT). The recurrence‐free survival (RFS) after 72 months of life‐table analysis is 44% in the RT + TAM treated group, and 40% in the RT group (p=0.0003). Survival is 51% in both treatment groups (p=0.53). The data have been further analyzed with respect to prognostic factors such as age, degree of anaplasia, tumor size, and positive nodes. The RFS is lower in all subsets of patients treated with RT + TAM, but is only significant in patients 50–59 years of age, with tumors of anaplasia grade I, with tumors less than 5 cm, or with 4 or more positive lymph nodes. Estrogen receptor concentrations were measured in a subset of 291 of these patients. A cut‐off limit of 10 fmol/mg cytosol protein and the use of a Cox proportional hazards model distinguished between patients with long RFS and those with early recurrent disease. Patients with an estrogen receptor content below 100 fmol/mg did not benefit from the endocrine therapy, while those with concentrations above 100 fmol/mg had a significantly longer RFS. Progesterone receptor determinations were performed in 12% of the patients. Progesterone receptor‐positive patients had a lower rate of recurrence when treated with RT + TAM compared to the receptor‐positive patients in the RT group (p=0.017). Résumé Le rôle du traitement anti‐oestrogénique du cancer du sein opéré après la ménopause chez les malades à hauts risques de récidive a été soumis à une étude prospective randomisée sur le plan national par le groupe Danois d'Etude du Cancer du Sein. Cette étude comporte d'une part 829 malades qui après mastectomie totale et radiothérapie postopératoire ont été traitées par le tamoxifen (RT + TAM) pendant un an et d'autre part 821 malades qui n'ont pas été soumises à un traitement complémentaire (RT). L'absence de récidive après 3 ans a été de 44% dans le premier groupe et de 40% dans le second. Dans les deux groupes le taux de la survie à 5 ans a été de 51% (p=0.53). Le pronostic basé sur les données rassemblées a été étudié en fonction de plusieurs facteurs: âge, degré d'anaplasie, volume de la tumeur, envahissement ganglion