Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: recurrence, metastases, second cancer and death

BMC Cancer

Research Article

Lucie Tanneau¹  Virginie Rondeau²  Marc Debled³  Gaétan MacGrogan³  Simone Mathoulin-Pélissier⁴  Annie J Sasco⁵ 

[1] INSERM, U897 (Biostatistique), ISPED, F-33076, Bordeaux, France;INSERM, U897 (Biostatistique), ISPED, F-33076, Bordeaux, France;Université Victor Segalen Bordeaux 2, F-33076, Bordeaux, France;Institut Bergonié - Centre Régional de Lutte Contre le Cancer du Sud-Ouest, F-33076, Bordeaux, France;Institut Bergonié - Centre Régional de Lutte Contre le Cancer du Sud-Ouest, F-33076, Bordeaux, France;INSERM, U897 (Team of Epidemiology for Cancer Prevention), F-33076, Bordeaux, France;Université Victor Segalen Bordeaux 2, F-33076, Bordeaux, France;INSERM, U897 (Team of Epidemiology for Cancer Prevention), F-33076, Bordeaux, France;

关键词: Breast Cancer;    Hazard Function;    Contralateral Breast Cancer;    Prior Event;    Progesterone Receptor Status;   

DOI  :  10.1186/1471-2407-10-697

 received in 2009-10-05, accepted in 2010-12-31,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundIn the setting of recurrent events, research studies commonly count only the first occurrence of an outcome in a subject. However this approach does not correctly reflect the natural history of the disease. The objective is to jointly identify prognostic factors associated with locoregional recurrences (LRR), contralateral breast cancer, distant metastases (DM), other primary cancer than breast and breast cancer death and to evaluate the correlation between these events.MethodsPatients (n = 919) with a primary invasive breast cancer and treated in a cancer center in South-Western France with breast-conserving surgery from 1990 to 1994 and followed up to January 2006 were included. Several types of non-independent events could be observed for the same patient: a LRR, a contralateral breast cancer, DM, other primary cancer than breast and breast cancer death. Data were analyzed separately and together using a random-effects survival model.ResultsLRR represent the most frequent type of first failure (14.6%). The risk of any event is higher for young women (less than 40 years old) and in the first 10 years of follow-up after the surgery. In the combined analysis histological tumor size, grade, number of positive nodes, progesterone receptor status and treatment combination are prognostic factors of any event. The results show a significant dependence between these events with a successively increasing risk of a new event after the first and second event. The risk of developing a new failure is greatly increased (RR = 4.25; 95%CI: 2.51-7.21) after developing a LRR, but also after developing DM (RR = 3.94; 95%CI: 2.23-6.96) as compared to patients who did not develop a first event.ConclusionWe illustrated that the random effects survival model is a more satisfactory method to evaluate the natural history of a disease with multiple type of events.

【 授权许可】

CC BY   
© Rondeau et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.