Conditional regional recurrence risk: The effect of event-free years in different subtypes of breast cancer

Marissa L.G. Vane*, Martine Moossdorff, Marissa C. van Maaren, Sander M.J. van Kuijk, Thiemo J.A. van Nijnatten, Lori M. van Roozendaal, Evert Jan G. Boerma, Johannes H.W. de WIlt, Marjolein L. Smidt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Regional recurrence (RR), also known as lymph node recurrence, is an endpoint in several trials concerning reducing axillary treatment in cT1-2N0 breast cancer patients. The risk of RR may decrease with each subsequent event-free year, affecting the yield and consequently usefulness of long (er) follow-up. The aim of this study is to determine the risk of RR as a first event within five years after diagnosis in subtypes of breast cancer, conditional to being event-free for one, two, three and four years. Methods: From the Netherlands Cancer Registry, cT1-2N0 breast cancer patients diagnosed from 2005 to 2008 were analyzed. Subgroup analysis was performed for pT1-2N+(sn) patients. RR risk was calculated with Kaplan-Meier analysis. Conditional RR (assuming x event-free years) was determined by selecting patients without an event at x years, and calculating the remaining risk for RR within five years after diagnosis. Results: A total of 18,009 cT1-2N0 (all pN stages) breast cancer patients were included. RR occurred in 1.3% of cT1-2N0 and 1.5% of pT1-2N+(sn) patients. The risk of RR varied between subtypes; it was highest for triple negative tumors and lowest for ER + PR + Her2-and ER + Her2+ tumors. After event-free years, the risk of RR decreased subsequently in both groups and in all subtypes. After two event-free years, the risk of RR was 0.8%. Conclusion: The absolute yield of follow-up to detect RR beyond two years is low; for every 125 event-free patients, one RR can be expected until five years. This suggests that follow-up longer than two years is of limited value for detecting RR in both clinical and research setting.

Original languageEnglish
Pages (from-to)1292-1298
Number of pages7
JournalEuropean journal of surgical oncology
Issue number6
Early online date27 Nov 2020
Publication statusPublished - 1 Jun 2021


  • Breast cancer
  • Conditional survival
  • Regional recurrence
  • Subtypes of breast cancer


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