ABCR  Vol.6 No.3 , July 2017
Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy
Abstract: Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts; earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.
Cite this paper: Yoshida, Y. , Obayasi, H. , Maetani, S. (2017) Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy. Advances in Breast Cancer Research, 6, 81-91. doi: 10.4236/abcr.2017.63007.

[1]   Cox, D.R. (2010) Summary Comments on Evolution of Cancer Survival Analysis. Surgical Oncology, 19, 49-61.

[2]   Cox, D.R. (1972) Regression Models and Life-Table. Journal of the Royal Statistical Society Series B, 34,187-220.

[3]   Peto, R. and Peto, J. (1972) Asymptotically Efficient Rank Invariant Test Procedures. Journal of the Royal Statistical Society Series A, 135, 185-206.

[4]   Boag, J.W. (1949) Maximum Likelihood Estimates of the Proportion of Patients Cured by Cancer Therapy. Journal of the Royal Statistical Society, 118, 15-53.

[5]   Rutqvist, L.E. and Wallgren, A. (1985) Long-Term Survival of 458 Young Breast Cancer Patients. Cancer, 55, 658-665.<658::AID-CNCR2820550331>3.0.CO;2-P

[6]   Gamel, J.W., Vogel, R.L. (1997) Comparison of Parametric and Non-Parametric Methods Using Simulated Clinical Data. Statistics in Medicine, 16, 1629-1643.<1629::AID-SIM594>3.0.CO;2-C

[7]   Sposto, R. (2002) Cure Model Analysis in Cancer: An Application to Data from the Children’s Cancer Group. Statistics in Medicine, 21, 293-312.

[8]   UICC (2010) Breast Tumours. In: Sobin, L.H., Gospodarowicz, M.K. and Wittekind, Ch., Eds., TNM Classification of Malignant Tumours, 7th Edition, Springer-Verlag, New York, 181-193.

[9]   Halsted, W.S. (1907) The Results of Radical Operations for the Cure of Carcinoma of the Breast. Annals of Surgery, 46, 1-19.

[10]   Gamel, J.W. and McLean, I.W. (1994) A Stable, Multivariate Extension of the Log-Normal Survival Model. Computer and Biostatistical Research, 27, 148-155.

[11]   Klein, J.P. and Moeschberger, M.L. (1997) Large-Sample Test Based on Likelihood Ratio Theory. In: Survival Analysis, Spring Science + Business Media, Inc., New York, 459-463.

[12]   Kalbfleisch, J.D. and Prentice, R.L. (1980) Comparison of Survival Curves. In: The Statistical Analysis of Failure Time Data, John Wiley & Sons, Inc., New York, 16-19.

[13]   Sakata, R., Grant, E.I. and Ozawa, K. (2012) Long-Term Follow-Up of Atomic Bomb Survivors. Maturitas, 72, 99-103.

[14]   Klipworth, L. (1965) Survival of Cases of Surgically Treated Mammary Carcinoma with and without Radiation Therapy. The Lancet, 286, 231-232.

[15]   Host, H., Brennhovd, I.O. and Loeb, M. (1986) Postoperative Radiotherapy in Breast Cancer: Long-Term Results from the Oslo Study. International Journal of Radiation Oncology * Biology * Physics, 12, 727-732.

[16]   EBCTCG (2002) Radiotherapy for Early Breast Cancer. Cochrane Database of Systemic Reviews, No. 2, Article No. CD003647.

[17]   Rutqvist, L.E., Rose, C. and Cavellin-Stahl, E. (2003) A Systematic Overview of Radiation Therapy Effects in Breast Cancer. Acta Oncologica, 42, 532-545.

[18]   EBCTCG (2005) Effect of Radiotherapy and of Difference in the Extent of Surgery for Early Breast Cancer on Local Recurrences and 15-Year Survival: An Overview of the Randomized Trials. The Lancet, 366, 2087-2106.

[19]   EBCTCG (2011) Effect of Radiotherapy after Breast-Conserving Surgery on 10-Year Recurrence and 15-Year Breast Cancer Death: Meta-Analysis of Individual Patient Data for 10801 Women in 17 Randomised Trials. The Lancet, 378, 1707-1716.

[20]   EBCTCG (2014) Effect of Radiotherapy after Mastectomy and Axillary Surgery on 10-Year Recurrence and 20 Year Breast Cancer Mortality: Meta-Analysis of Individual Patient Data for 8135 Women in Randomized Trials. The Lancet, 383, 2127-2135.

[21]   Hennequin, C. and Fourquet, A. (2014) Controversy about Internal Mammary Chain Irradiation in Breast Cancer. Cancer Radiotherapie, 18, 3515.

[22]   Poortmans, P.M., Collette, S., Kirkovw, C., et al. (2015) Internal Mammary and Medical Supraclavicular Irradiation in Breast Cancer. The New England Journal of Medicine, 373, 317-327.

[23]   Drooger, J.C., Hooning, M.J., Seynaeve, C.M., et al. (2015) Diagnostic and Therapeutic Ionizing Radiation and the Risk of a First and Second Primary Breast Cancer, with Special Attention for BRCA1 and BRCA2 Mutation Carriers: A Critical Review of the Literature. Cancer Treatment Review, 41, 187-196.

[24]   Weiden, P.L. (1990) Do Perioperative Blood Transfusions Increase the Risk of Cancer Recurrence? European Journal of Cancer, 26, 987-989.

[25]   Bhagwat, G.P. (1990) Blood Transfusion and Cancer Recurrence: A Brief Review. Bahrain, 12, 79-83.

[26]   Dellinger, E.P. and Anaya, D.A. (2004) Infectious and Immunologic Consequences of Blood Transfusion. Critical Care, 8, S18-S23.

[27]   Vamvakas, E.C. and Blajchman, M.A. (2007) Transfusion-Related Immunomodulation (TRIM): An Update. Blood Reviews, 21, 327-348.

[28]   Cata, J.P., Wang, H., Gottumukkala, V., Rheuban, J. and Sessler, D.I. (2013) Inflammatory Response, Immunosuppression, and Cancer Recurrence after Perioperative Blood Transfusion. British Journal of Anaesthesia, 110, 690-701.

[29]   Valco, R.L. (1956) Principles of Pre- and Postoperative Care. In: Davis, L., Ed., Christopher’s Textbook of Surgery, 6th Edition, W. B. Saunders, Philadelphia, 109-142.

[30]   Maetani, S. and Gamel, J.W. (2013) Parametric Cure Model versus Proportional Hazards Model in Survival Analysis of Breast Cancer and Other Malignancies. Advances in Breast Cancer Research, 2, 119-125.