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Time-dependent effects on survival in breast carcinoma

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Warwick, Jane, Tabàr, Lazlo, Vitak, Bedrich and Duffy, Stephen W. (2004) Time-dependent effects on survival in breast carcinoma. Cancer, Volume 100 (Number 7). pp. 1331-1336. doi:10.1002/cncr.20140 ISSN 0008-543X.

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Official URL: http://dx.doi.org/10.1002/cncr.20140

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Abstract

Background:
Tumor size, lymph node status, and histologic grade are reported to be important predictors of survival in the first 5 years after the diagnosis of invasive breast carcinoma. However, to the authors' knowledge, the effect of these factors in the longer term (> 10 years after diagnosis) is not yet clear.

Methods:
It is now > 20 years since the Swedish Two-County Trial of breast carcinoma screening with mammography was instigated and long-term follow-up is now available to December 1998. In the current study, the authors analyzed the effects of tumor size, lymph node status, and tumor grade on survival to death from breast carcinoma using Cox regression and frailty models that allow the baseline hazard and/or effect of a covariate to vary with time.

Results:
The effects of tumor size, lymph node status, and tumor grade were shown to progressively diminish with time from diagnosis. The Cox regression model with time-varying coefficients and a dampening parameter then was fitted to allow for the attenuation of prognostic effects; tumor size, lymph node status, and tumor grade were all found to be highly significant (P < 0.001).

Conclusions:
The results of the current study suggest that long-term survival in women with invasive breast carcinoma could be modelled satisfactorily using either frailty models or Cox regression models with time-varying coefficients. The results also suggest that the value of tumor grade, lymph node status, and tumor size at the time of diagnosis have a lasting influence on subsequent survival, albeit attenuated in later years. The long-term effects of these prognostic factors may explain the fact that the impact of mass screening programs on breast carcinoma mortality rates is still apparent many years later.

Item Type: Journal Article
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title: Cancer
Publisher: John Wiley & Sons, Inc.
ISSN: 0008-543X
Official Date: 1 April 2004
Dates:
DateEvent
1 April 2004Published
Volume: Volume 100
Number: Number 7
Page Range: pp. 1331-1336
DOI: 10.1002/cncr.20140
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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