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Published on: December 15, 2014
Long-term Survival in Breast Cancer Patients Is Associated with Contralateral Parenchymal Enhancement at MRI:
Max A A Ragusi1, Bas H M van der Velden1, Carla Meeuwis1
1From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.).
Abstract:
Background Several single-center studies found that high contralateral parenchymal enhancement (CPE) at breast MRI was associated with improved long-term survival in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Due to varying sample sizes, population characteristics, and follow-up times, consensus of the association is currently lacking. Purpose To confirm whether CPE is associated with long-term survival in a large multicenter retrospective cohort, and to investigate if CPE is associated with endocrine therapy effectiveness. Materials and Methods This multicenter observational cohort included women with unilateral ER-positive HER2-negative breast cancer (tumor size ≤50 mm and ≤three positive lymph nodes) who underwent MRI from January 2005 to December 2010. Overall survival (OS), recurrence-free survival (RFS), and distant RFS (DRFS) were assessed. Kaplan-Meier analysis was performed to investigate differences in absolute risk after 10 years, stratified according to CPE tertile. Multivariable Cox proportional hazards regression analysis was performed to investigate whether CPE was associated with prognosis and endocrine therapy effectiveness. Results Overall, 1432 women (median age, 54 years [IQR, 47-63 years]) were included from 10 centers. Differences in absolute OS after 10 years were stratified according to CPE tertile as follows: 88.5% (95% CI: 88.1, 89.1) in tertile 1, 85.8% (95% CI: 85.2, 86.3) in tertile 2, and 85.9% (95% CI: 85.4, 86.4) in tertile 3. CPE was independently associated with OS, with a hazard ratio (HR) of 1.17 (95% CI: 1.0, 1.36; P = .047), but was not associated with RFS (HR, 1.11; P = .16) or DRFS (HR, 1.11; P = .19). The effect of endocrine therapy on survival could not be accurately assessed; therefore, the association between endocrine therapy efficacy and CPE could not reliably be estimated. Conclusion High contralateral parenchymal enhancement was associated with a marginally decreased overall survival in patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative breast cancer, but was not associated with recurrence-free survival (RFS) or distant RFS. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Honda and Iima in this issue.
