Breast cancer in a tertiary cancer center in India - An audit, with outcome analysis

Background: Survival studies may serve as benchmarks to develop cancer-related policies and estimate baseline survival rates in a given patient population. Materials and Methods: We carried out a retrospective audit of cases managed in 2009 and now report the disease-free survival (DFS) in early breast cancer (EBC) and locally advanced breast cancer (LABC) in patients registered at a tertiary cancer center in India. Results: The study included 2192 patients with breast cancer with ages ranging from 18 years to 94 years with a median of 50 years. Of these, 888 (40.5%) were EBCs Stage I and II, 833 (38%) were LABCs (Stage III), and 471 (21.5%) were de novo metastatic or relapsed cancers at presentation. The 5-year DFS in the women with EBC was 85.5% and in LABC, it was 67.7%, P P P P = 0.001), and human epidermal growth factor receptor 2 (Her2neu) positivity ( P = 0.033). In the multivariate Cox regression analysis in EBC, node-positive status (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.51–3.45, P P = 0.001) significantly affected DFS in EBC. The factors adversely affecting DFS in LABC in the univariate analysis were node metastasis ( P P P P P = 0.03). In the multivariate Cox regression analysis, node positivity (HR 2.96, 95% CI 2.04–4.29, P P = 0.023), and mastectomy (HR 1.49, 95% CI 1.06–2.10, P = 0.023) adversely impacted DFS in LABC. Conclusions: The survival rates in this study are equal to the documented global rates; nodal disease burden emerged as the most important prognostic factor. In addition, in EBCs, a lack of hormone receptor expression and in LABC, Her2neu overexpression appear to worsen the outcome.