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Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 18–40 Years at Diagnosis: The POSH Study

Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 18–40 Years at Diagnosis: The POSH Study
Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 18–40 Years at Diagnosis: The POSH Study
Background: Breast cancer at a young age is associated with poor prognosis. The Prospective Study of Outcomes in Sporadic and Hereditary Breast Cancer (POSH) was designed to investigate factors affecting prognosis in this patient group.

Methods: Between 2000 and 2008, 2956 patients aged 40 years or younger were recruited to a UK multicenter prospective observational cohort study (POSH). Details of tumor pathology, disease stage, treatment received, and outcome were recorded. Overall survival (OS) and distant disease-free interval (DDFI) were assessed using Kaplan-Meier curves. All statistical tests were two-sided.

Results: Median age of patients was 36 years. Median tumor diameter was 22mm, and 50% of patients had positive lymph nodes; 59% of tumors were grade 3, 33.7% were estrogen receptor (ER) negative, and 24% were human epidermal growth factor receptor 2 (HER2) positive. Five-year OS was higher for patients with ER-positive than ER-negative tumors (85.0%, 95% confidence interval [CI] = 83.2% to 86.7% vs 75.7%, 95% CI = 72.8% to 78.4%; P < .001), but by eight years, survival was almost equal. The eight-year OS of patients with ER-positive tumors was similar to that of patients with ER-negative tumors in both HER2-positive and HER2-negative subgroups. The flexible parametric survival model for OS shows that the risk of death increases steadily over time for patients with ER-positive tumors in contrast to patients with ER-negative tumors, where risk of death peaked at two years.

Conclusions: These results confirm the increased frequency of ER-negative tumors and early relapse in young patients and also demonstrate the equally poor longer-term outlook of young patients who have ER-positive tumors with HER2-negative or -positive disease.
0027-8874
978-988
Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Eccles, Bryony
57ff1cdf-577d-421d-8f35-b12b8d1c2030
Maishman, Tom
cf4259a4-0eef-4975-9c9d-a2c3d594f989
Gerty, Sue
b2013815-27c9-4a7d-ad42-071f60a8000f
Stanton, L.
8b827763-d839-4b4b-bbf2-358a84110294
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Altman, Douglas G.
f0d739a4-dc94-44d1-a497-603a3ed7d7e6
Durcan, Lorraine
bd059b41-9e77-4afe-b271-9ac4c91a05c6
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Lawrence, Gill
9fd73743-1884-43b1-b3aa-f6ec08a38a26
Jones, Louise
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Bliss, Judith
e25f12ca-62ea-4ebe-88c0-83bf33f65354
Eccles, Diana
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Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Eccles, Bryony
57ff1cdf-577d-421d-8f35-b12b8d1c2030
Maishman, Tom
cf4259a4-0eef-4975-9c9d-a2c3d594f989
Gerty, Sue
b2013815-27c9-4a7d-ad42-071f60a8000f
Stanton, L.
8b827763-d839-4b4b-bbf2-358a84110294
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Altman, Douglas G.
f0d739a4-dc94-44d1-a497-603a3ed7d7e6
Durcan, Lorraine
bd059b41-9e77-4afe-b271-9ac4c91a05c6
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Lawrence, Gill
9fd73743-1884-43b1-b3aa-f6ec08a38a26
Jones, Louise
68ce5626-a7bb-4856-93f3-77502a235d5e
Bliss, Judith
e25f12ca-62ea-4ebe-88c0-83bf33f65354
Eccles, Diana
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23

Copson, Ellen, Eccles, Bryony, Maishman, Tom, Gerty, Sue, Stanton, L., Cutress, Ramsey I., Altman, Douglas G., Durcan, Lorraine, Simmonds, Peter, Lawrence, Gill, Jones, Louise, Bliss, Judith and Eccles, Diana (2013) Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 18–40 Years at Diagnosis: The POSH Study. JNCI Journal of the National Cancer Institute, 105 (13), 978-988. (doi:10.1093/jnci/djt134). (PMID:23723422)

Record type: Article

Abstract

Background: Breast cancer at a young age is associated with poor prognosis. The Prospective Study of Outcomes in Sporadic and Hereditary Breast Cancer (POSH) was designed to investigate factors affecting prognosis in this patient group.

Methods: Between 2000 and 2008, 2956 patients aged 40 years or younger were recruited to a UK multicenter prospective observational cohort study (POSH). Details of tumor pathology, disease stage, treatment received, and outcome were recorded. Overall survival (OS) and distant disease-free interval (DDFI) were assessed using Kaplan-Meier curves. All statistical tests were two-sided.

Results: Median age of patients was 36 years. Median tumor diameter was 22mm, and 50% of patients had positive lymph nodes; 59% of tumors were grade 3, 33.7% were estrogen receptor (ER) negative, and 24% were human epidermal growth factor receptor 2 (HER2) positive. Five-year OS was higher for patients with ER-positive than ER-negative tumors (85.0%, 95% confidence interval [CI] = 83.2% to 86.7% vs 75.7%, 95% CI = 72.8% to 78.4%; P < .001), but by eight years, survival was almost equal. The eight-year OS of patients with ER-positive tumors was similar to that of patients with ER-negative tumors in both HER2-positive and HER2-negative subgroups. The flexible parametric survival model for OS shows that the risk of death increases steadily over time for patients with ER-positive tumors in contrast to patients with ER-negative tumors, where risk of death peaked at two years.

Conclusions: These results confirm the increased frequency of ER-negative tumors and early relapse in young patients and also demonstrate the equally poor longer-term outlook of young patients who have ER-positive tumors with HER2-negative or -positive disease.

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Published date: 30 May 2013
Organisations: Faculty of Medicine, Clinical Trials Unit

Identifiers

Local EPrints ID: 353191
URI: http://eprints.soton.ac.uk/id/eprint/353191
ISSN: 0027-8874
PURE UUID: e69e4460-92d9-4443-bad9-316275835c90
ORCID for L. Stanton: ORCID iD orcid.org/0000-0001-8181-840X
ORCID for Diana Eccles: ORCID iD orcid.org/0000-0002-9935-3169

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Date deposited: 03 Jun 2013 12:58
Last modified: 19 Feb 2021 02:33

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Contributors

Author: Ellen Copson
Author: Bryony Eccles
Author: Tom Maishman
Author: Sue Gerty
Author: L. Stanton ORCID iD
Author: Douglas G. Altman
Author: Lorraine Durcan
Author: Peter Simmonds
Author: Gill Lawrence
Author: Louise Jones
Author: Judith Bliss
Author: Diana Eccles ORCID iD

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