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Iwamoto T, Kumamaru H, Niikura N, Sagara Y, Miyashita M, Konishi T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Watanabe C, Kinukawa N, Toi M, Saji S. Survival trends and patient characteristics between 2004 and 2016 for breast cancer in Japan based on the National Clinical Database-Breast Cancer Registry. Breast Cancer 2024; 31:185-194. [PMID: 38319565 DOI: 10.1007/s12282-024-01545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
This is a prognostic report by the Japanese Breast Cancer Society on breast cancer extracted from the National Clinical Database-Breast Cancer Registry of Japan. Here, we present a summary of 457,878 breast cancer cases registered between 2004 and 2016. The median follow-up duration was 5.6 years. The median age at the start of treatment was 59 years (5-95%: 38-82 years) and increased from 57 years between 2004 and 2008 to 60 years between 2013 and 2016. The proportion of patients with Stage 0-II disease increased from 74.5% to 78.3%. The number of cases with estrogen and progesterone receptor positivity increased from 74.8% to 77.9% and 60.5% to 68.1%, respectively. Regarding (neo-)adjuvant chemotherapy, the taxane (T) or taxane-cyclophosphamide (C) regimen increased by 2.4% to 8.2%, but the (fluorouracil (F)) adriamycin (A)-C-T/(F) epirubicin (E)C-T and (F)AC/(F)EC regimens decreased by 18.6% to 15.2% and 13.5% to 5.0%, respectively. Regarding (neo-)adjuvant anti-human epidermal growth factor-2 (HER2)-targeted therapy, the use of trastuzumab increased from 4.6% to 10.5%. The rate of sentinel lymph node biopsy increased from 37.1% to 60.7%, while that of axillary dissection decreased from 54.5% to 22.6%. Improvements in disease-free and overall survival were observed in patients with HER2-positive breast cancer, but there was no apparent trend in patients with hormone receptor-positive, HER2-negative, or triple-negative breast cancers.
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Affiliation(s)
- Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Okayama, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Social Medical Corporation Hakuaikai, Sagara Hospital, Kagoshima, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Miyagi, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Mie, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Naoki Hayashi
- Department of Surgery, Division of Breast Surgical Oncology, Showa University, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Sagara Y, Kumamaru H, Niikura N, Miyashita M, Konishi T, Iwamoto T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Kinukawa N, Watanabe C, Toi M, Saji S. 2020 Annual Report of National Clinical Database-Breast Cancer Registry: 10-year mortality of elderly breast cancer patients in Japan. Breast Cancer 2024; 31:179-184. [PMID: 38180641 DOI: 10.1007/s12282-023-01532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
The Japanese Breast Cancer Society initiated the breast cancer registry in 1975, which transitioned to the National Clinical Database-Breast Cancer Registry in 2012. This annual report presents data from 2020 and analyzes the ten-year mortality rates for those aged 65 and older. We analyzed data from 93,784 breast cancer (BC) cases registered in 2020 and assessed 10-year mortality rates for 36,279 elderly patients diagnosed between 2008 and 2012. In 2020, 99.4% of BC cases were females with a median age of 61. Most (65%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery rates varied with stages: 58.5% at cStage I, 30.8% at cStage II, and 13.1% at cStage III. Sentinel lymph node biopsy was done in 73.6% of cases, followed by radiotherapy in 70% of those post-conserving surgery and chemotherapy in 21.1% post-surgery. Pathology showed that 63.4% had tumors under 2.0 cm, 11.7% had pTis tumors, and 77.3% had no axillary lymph node metastasis. ER positivity was seen in 75.1%, HER2 in 14.3%, and 30% had a Ki67 positivity rate above 30%. Across all stages and subtypes, there was a trend where the 10-year mortality rates increased for individuals older than 65 years. In Stage I, many deaths were not directly linked to BC and, for those with HER2-type and triple-negative BC, breast cancer-related deaths increased with age. Within Stage II, patients older than 70 years with luminal-type BC often experienced deaths not directly linked to BC, whereas patients below 80 years with HER2-type and triple-negative BC, likely had breast cancer-related deaths. In Stage III, breast cancer-related deaths were more common, particularly in HER2 and triple-negative BC. Our prognostic analysis underscores distinct mortality patterns by stage, subtype, and age in elderly BC patients. It highlights the importance of personalized treatment strategies, considering subtype-specific aggressiveness, age-related factors, and comorbidities.
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Affiliation(s)
- Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Medical Corporation, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-0833, Japan.
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Seiryo‑Machi, Aoba‑Ku, Sendai, 980‑8574, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda‑Izumicho, Chiyoda‑Ku, Tokyo, 101‑8643, Japan
| | - Masayuki Nagahashi
- Division of Breast and Endocrine Surgery, Department of Surgery, School of Medicine, Hyogo Medical University, 1‑1 Mukogawa, Nishinomiya, Hyogo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9‑1 Akashicho, Chuo‑Ku, Tokyo, 104‑8560, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku, Tokyo, 104‑0045, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Komagome Hospital, 3 Chome-18 Honkomagome, Bunkyo City, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Okuyama A, Takei J, Ogawa A. Perioperative treatments for and postoperative activity of daily living of patients with early-stage breast cancer according to age group: A retrospective observational study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107323. [PMID: 38113554 DOI: 10.1016/j.ejso.2023.107323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The number of older patients with breast cancer is increasing worldwide. However, no studies have clarified to what extent activities of daily living (ADL) decline in older patients after surgery. This study aimed to identify perioperative treatments and the proportion of patients with a postoperative decline in ADL among those with early-stage breast cancer, according to age groups (<65, 65-74, ≥75 years). MATERIALS AND METHODS This retrospective study used healthcare utilization data of women aged ≥40 years who were diagnosed with breast cancer in 431 Japanese hospitals. Patients who underwent breast conserving surgery and mastectomy at clinical stages 0-III were included. ADL were assessed using the Barthel index (100 points indicated independent ADL). RESULTS Overall, 37,161 patients were analyzed, including 17,313 undergoing a breast conserving surgery and 19,848 undergoing a mastectomy. The difference in the proportion of patients with a postoperative decline in ADL between those in the <65-year and ≥75-year group who underwent mastectomy was approximately 1%. In each age group, a higher proportion of patients received adjuvant chemotherapy (9.4-27.5% for breast conserving surgery; 15.6-40.3% for mastectomy) than neoadjuvant chemotherapy (breast conserving surgery, 2.1-12.0%; mastectomy, 3.0-18.1%). A lower proportion of patients in the ≥75-year group underwent radiotherapy than that in the <65-year group. CONCLUSION Physical burden of surgery was low in both younger and older patients. Low proportions of patients in the ≥75-year group who underwent surgery received neoadjuvant and adjuvant chemotherapy and adjuvant radiotherapy. Healthcare providers should inform this to patients.
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Affiliation(s)
- Ayako Okuyama
- Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Junko Takei
- Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Asao Ogawa
- Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Japan, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Miyashita M, Kumamaru H, Niikura N, Sagara Y, Konishi T, Iwamoto T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Watanabe C, Kinukawa N, Toi M, Saji S. Annual report of the Japanese Breast Cancer Registry for 2019. Breast Cancer 2024; 31:16-23. [PMID: 38044372 DOI: 10.1007/s12282-023-01526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
This is an annual report by the Japanese Breast Cancer Society regarding the clinical data on breast cancer extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR) of Japan. Here, we present an updated summary of 98,300 breast cancer cases registered in 2019. The median age at cancer diagnosis was 61 years (interquartile range 49-72 years), and 30.6% of the breast cancer patients were premenopausal. Of the 93,840 patients without distant metastases, 14,118 (15.0%) and 42,047 (44.8%) were diagnosed with stage 0 and I disease, respectively. Breast-conserving surgery was performed in 42,080 (44.8%) patients. Regarding axillary procedures, 62,677 (66.8%) and 7371 (7.9%) patients underwent sentinel node biopsy and axillary node dissection after biopsy, respectively. Whole breast irradiation was administered to 29,795 (70.8%) of the 42,080 patients undergoing breast-conserving surgery. Chest wall irradiation was administered to 5524 (11.1%) of the 49,637 patients who underwent mastectomy. Of the 6912 clinically lymph node-negative patients who received preoperative therapy, 5250 (76.0%) and 427 (6.2%) underwent sentinel node biopsy and axillary node dissection after biopsy, respectively; however, 602 (8.7%) patients initially underwent axillary node dissection without biopsy.
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Affiliation(s)
- Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259‑1193, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Social Medical Corporation Hakuaikai, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-833, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113-8655, Japan
| | - Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda‑Izumicho, Chiyoda‑Ku, Tokyo, 101‑8643, Japan
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, 1‑1 Mukogawa, Nishinomiya, Hyogo, 663‑8501, Japan
| | - Naoki Hayashi
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku, Tokyo, 104‑0045, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, 1865 Tokaichibacho, Midori-Ku, Yokohama-Shi, Kanagawa, 226-8555, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Komagome Hospital, 3 Chome-18 Honkomagome, Bunkyo City, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Hattori M, Masuda N, Takano T, Tsugawa K, Inoue K, Matsumoto K, Ishikawa T, Itoh M, Yasojima H, Tanabe Y, Yamamoto K, Suzuki M, Pan W, Cortes J, Iwata H. Pembrolizumab plus chemotherapy in Japanese patients with triple-negative breast cancer: Results from KEYNOTE-355. Cancer Med 2023; 12:10280-10293. [PMID: 36916728 DOI: 10.1002/cam4.5757] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Pembrolizumab plus chemotherapy improved progression-free survival (PFS) and overall survival (OS) compared with placebo plus chemotherapy in patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer with tumor programmed cell death ligand 1 (PD-L1) combined positive score (CPS) ≥10 in the global, phase 3, randomized controlled trial KEYNOTE-355. We report results for patients enrolled in Japan. Patients were randomized 2:1 to pembrolizumab 200 mg or placebo Q3W for 35 cycles plus chemotherapy (nab-paclitaxel, paclitaxel, or gemcitabine-carboplatin). Primary endpoints were PFS per RECIST version 1.1 by blinded independent central review and OS in patients with PD-L1 CPS ≥10, PD-L1 CPS ≥1, and the intention-to-treat (ITT) population. No alpha was assigned to this exploratory analysis. Eighty-seven patients were randomized in Japan (pembrolizumab plus chemotherapy, n = 61; placebo plus chemotherapy, n = 26), 66 (76%) had PD-L1 CPS ≥1, and 28 (32%) had PD-L1 CPS ≥10. Median time from randomization to data cutoff (June 15, 2021) was 44.7 (range, 37.2-52.9) months in the ITT population. Hazard ratios (HRs; 95% CI) for OS were 0.36 (0.14-0.89), 0.52 (0.30-0.91), and 0.46 (0.28-0.77) in the PD-L1 CPS ≥10, PD-L1 CPS ≥1, and ITT populations, respectively. HRs (95% CI) for PFS were 0.52 (0.20-1.34), 0.61 (0.35-1.06), and 0.64 (0.39-1.05). Grade 3 or 4 treatment-related adverse events occurred in 85% of patients in each group (no grade 5 events). Consistent with the global population, pembrolizumab plus chemotherapy tended to show improvements in OS and PFS with manageable toxicity versus placebo plus chemotherapy in Japanese patients and supports this combination in this setting.
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Affiliation(s)
| | - Norikazu Masuda
- Nagoya University Graduate School of Medicine, Nagoya, Japan.,National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Toshimi Takano
- The Cancer Institute Hospital of JFCR, Tokyo, Japan.,Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | - Mitsuya Itoh
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroyuki Yasojima
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | | | - Wilbur Pan
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain and Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
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