Research Article
Disease-free Survival and Metastases Pattern in Breast Cancer Patients after Mastectomy: An Application of Stratified Markov Model

M.R. Gohari, M. Mahmoudi, K. Mohammed, Y. Pasha and R. Khodabakhshi

International Journal of Cancer Research, 2006, 2(1), 10-18.

Abstract

This study designed and carried out to determine the disease-free survival of breast cancer patients after surgery and to assess its associated factors. The variability in effect of prognostic factors over time was also assessed. For this purpose one hundred seventeen women with breast cancer operated on at three hospitals in Tehran, Iran between 1990 and 2003 were enrolled in study. Since the occurrences of successive metastases in any patient are correlated and the occurrence of one metastasis may make further events more or less likely we used a Stratified Markov model to account for within-subject correlation in event times. This model stratifies data by event so that the baseline hazard is allowed to vary with each metastasis. In this model effect of covariates on the hazard of event is also estimated in each stratum, separately. The variables of age at time of surgery, number of positive lymph nodes, histologic grade, size of tumor, ER status, P53 and Her2 were considered in the model. Median follow up time for patients in study was 26 months after surgery. During the follow up time 44(38%) patients developed metastasis. 20(45%) of those experienced the second metastasis. The median disease-free survival for patients in study was 49.6 month and the median time to experience the second metastasis was 22.5 month. Risk of occurrence of a metastasis in the first year after mastectomy was 12%. Up to the second and fifth years risk of experience a metastasis was 32 and 69%, respectively. The rate of metastasis in our study was higher than some other countries. One reason for highly rate of relapse in patients is the fact that patients sought medical attention when the disease has reached an advanced stage. Stratified Markov model showed that the effect of prognostic factors was different for the first and the second metastasis. Size of tumor and number of positive lymph nodes had a significant effect on the risk of first metastasis. While tumor size was the only factor that affected hazard of the second metastasis. One possible reason for this finding is that the effect of these factors was mixed with the effect of time to first metastasis and we can`t separate them in analysis of the second time.

ASCI-ID: 36-24

Cited References Fulltext

Similar Articles


Immunohistological Localization of Human FAT1 (hFAT) Protein in 326 Breast Cancers. Does this Adhesion Molecule Have a Role in Pathogenesis?

International Journal of Cancer Research, 2006, 2(3), 257-266.

Level of Expression of Parathyroid Hormone Related Protein and its Receptor in Human Breast Cancer and its Correlation with the Clinical Outcome

International Journal of Cancer Research, 2007, 3(2), 92-102.

Impact of Positive Family History on the Survival of Breast Cancer in Iran

International Journal of Cancer Research, 2007, 3(3), 157-161.

Cytotoxic Potential on Breast Cancer Cells Using Selected Forest Species Found in Malaysia

International Journal of Cancer Research, 2008, 4(3), 103-109.

Risk Factors for Breast Cancer in Iranian Women: A Case-Control Study

International Journal of Cancer Research, 2009, 5(1), 1-11. DOI:

Protective Effect of Green Alage Against 7,12-Dimethylbenzanthracene (DMBA)-Induced Breast Cancer in Rats

International Journal of Cancer Research, 2009, 5(1), 12-24.

Cytotoxic Effect of Cayratia carnosa Leaves on Human Breast Cancer Cell Lines

International Journal of Cancer Research, 2009, 5(3), 115-122.

In vitro Cytotoxic and Apoptotic Properties of the Stem Bark Extract of Sandoricum koetjape on Breast Cancer Cells

International Journal of Cancer Research, 2009, 5(3), 123-129.

Sentinel Lymph Node Biopsy in Intraductal Carcinoma of the Breast with Microinvasion

International Journal of Cancer Research, 2005, 1(1), 1-4.

Expression of Cyclin D1 in Tamoxifen Resistant Subline of Human Breast Cancer T47D Cells

International Journal of Cancer Research, 2005, 1(1), 16-20.

Breast Cancer and Food: A Quasi-epidemiological Evidence of a Role for Dietary Phytoestrogens in Northwestern Nigerian Women

International Journal of Cancer Research, 2005, 1(1), 21-24.

Methylenetetrahydrofolate Reductase (MTHFR) C677T and A1298C Polymorphisms and Breast Cancer in South Indian Population

International Journal of Cancer Research, 2006, 2(2), 143-151.

Anti-tumor Activity of New Quinoline Derivatives in Human Breast Cancer T47D Cells

International Journal of Cancer Research, 2006, 2(2), 102-108.

Molecular Modelling Analysis of the Metabolism of Letrozole

International Journal of Cancer Research, 2006, 2(4), 403-408.

Differential Expression of TS and TP in Tamoxifen Resistant Subline of Human Breast Cancer T47D Cells

International Journal of Cancer Research, 2005, 1(2), 113-117.

Choroidal Metastasis as First Manifestation Following Breast Conserving Surgery for Breast Cancer: Case Report

International Journal of Cancer Research, 2006, 2(3), 299-302.

Research of Epstein-Barr Virus Genome and Quantification of Viral Load in Algerian Frozen Tissue of Breast Cancer

International Journal of Cancer Research, 2015, 11(1), 32-40.

Anti-Cancer Effect and Mechanisms of Action of Mikania cordata Plant Extract on MCF-7 Human Breast Adenocarcinoma Cells

International Journal of Cancer Research, 2015, 11(2), 80-92.

Mucoxin (Acetogenin) Inhibits Proliferation of T47D Breast Cancer by Suppressing Expression of Cyclin D1 Mediated by p53

International Journal of Cancer Research, 2016, 12(2), 101-108.

Identification of Target Genes in Breast Cancer Pathway using Protein-Protein Interaction Network

International Journal of Cancer Research, 2017, 13(2), 51-58.

Deletion of the Alu Repeat in the Tissue Plasminogen Activator (tPA) Gene For Protection of Breast Cancer

International Journal of Cancer Research, 2018, 14(1), 21-26.

CD74 a Potential Therapeutic Target for Breast Cancer Therapy: Interferon Gamma Up-regulates its Expression in CAMA-1 and MDA-MB-231 Cancer Cells

International Journal of Cancer Research, 2018, 14(2), 58-69.

Newly Synthesized Palladium (II) Complex ASH10 Induces Apoptosis and Autophagy in Breast Cancer Cells

International Journal of Cancer Research, 2020, 16(2), 40-47.

Zinc Inhibits Tumor Metastasis by Regulating Plasminogen Activation

International Journal of Cancer Research, 2006, 2(4), 376-382.

Malignancies in Clitoris: A Review of Literature on Etiology, Diagnosis, Pathology and Treatment Strategies

International Journal of Cancer Research, 2008, 4(4), 110-126.

Sentinel Lymph Node Biopsy in Intraductal Carcinoma of the Breast with Microinvasion

International Journal of Cancer Research, 2005, 1(1), 1-4.

Choroidal Metastasis as First Manifestation Following Breast Conserving Surgery for Breast Cancer: Case Report

International Journal of Cancer Research, 2006, 2(3), 299-302.

Withdrawn: N-myc Downstream Regulated Gene1 (NDRG1) in Cancer Metastasis and Therapeutics

International Journal of Cancer Research, 2016, 12(2), 122-127.

Deletion of the Alu Repeat in the Tissue Plasminogen Activator (tPA) Gene For Protection of Breast Cancer

International Journal of Cancer Research, 2018, 14(1), 21-26.

Haemostatic Changes in Patients with Lymphoid Malignancies on Chemotherapy in Benin City, Edo State

International Journal of Cancer Research, 2022, 18(1), 1-5.

Cited By


Impact of Positive Family History on the Survival of Breast Cancer in Iran

International Journal of Cancer Research, 2007, 3(3), 157. DOI: 10.3923/ijcr.2007.157.161