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  • Jurrius, PatriekKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, England (author)

Invasive breast cancer over four decades reveals persisting poor metastatic outcomes in treatment resistant subgroup - the "ATRESS" phenomenon

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • CHURCHILL LIVINGSTONE,2020
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-408530
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-408530URI
  • https://doi.org/10.1016/j.breast.2020.01.006DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Background: Major advances in breast cancer treatment have led to a reducuction in mortality. However, there are still women who are not cured. We hypothesize there is a sub-group of women with treatment-resistant cancers causing early death.Methods: Between 1975 and 2006, 5392 women with invasive breast cancer underwent surgery at Guy's Hospital, London. Data on patient demographics, tumour characteristics, treatment regimens, local recurrence, secondary metastasis, and death were prospectively recorded. We considered four time periods (1975-1982, 1983-1990, 1991-1998, 1999-2006). Risks and time to event analysis were performed with Cox proportional hazards model and Kaplan-Meier estimation.Results: Unadjusted hazard ratios for developing metastasis and overall mortality relative to the 1975-1982 cohort decreased steadily to 0.23 and 0.63, respectively in 1999-2006. However, metastasis-free interval shortened, with the proportion of women developing metastasis <= 5 years increasing from 73.9% to 83.0%. Furthermore, median post-metastatic survival decreased from 1.49 years to 0.94 years. Applying our risk criteria identified the presence of +/- 200 patients in each cohort who developed metastasis early and died within a much shorter time frame.Conclusions: Advances in treatment have decreased the risk of metastasis and improved survival in women with invasive breast cancer over the last 40 years. Despite this, a subpopulation with shorter metastasis-free and post-metastatic survival who are unresponsive to available treatment remains. This may be due to the ATRESS phenomenon (adjuvant therapy-related shortening of survival) secondary to preselection inherent in adjuvant therapy, successful treatment of less malignant tumour cells and treatment-induced resistance in the remaining tumour clones.

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  • Green, ThomasKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Garmo, HansKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Young, MatthewKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Cariati, MassimilianoKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, England (author)
  • Gillett, CherylKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Mera, AncaKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Harries, MarkKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, England (author)
  • Grigoriadis, AnitaKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (author)
  • Pinder, SarahKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, England (author)
  • Holmberg, LarsUppsala universitet,Endokrinkirurgi,Kings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England(Swepub:uu)larsholmb (author)
  • Purushotham, ArnieKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, England (author)
  • Kings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England;Guys & St Thomas NHS Fdn Trust, London SE1 9RT, EnglandKings Coll London, Sch Canc & Pharmaceut Sci, London SE1 9RT, England (creator_code:org_t)

Related titles

  • In:Breast: CHURCHILL LIVINGSTONE50, s. 39-480960-97761532-3080

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