Abstract Background Guidelines for follow-up after locoregional breast cancer treatment recommend imaging for distant metastases only in the presence of patient signs and/or symptoms. However, guidelines have not been updated to reflect advances in imaging, systemic therapy, or the understanding of biological subtype. We assessed the association between mode of distant recurrence detection and survival. Methods In this observational study, a stage-stratified random sample of women with stage II-III breast cancer in 2006-2007 and followed through 2016 was selected, including up to 10 women from each of 1217 Commission on Cancer facilities (n = 10 076). The explanatory variable was mode of recurrence detection (asymptomatic imaging vs signs and/or symptoms). The outcome was time from initial cancer diagnosis to death. Registrars abstracted scan type, intent (cancer-related vs not, asymptomatic surveillance vs not), and recurrence. Data were merged with each patient’s National Cancer Database record. Results Surveillance imaging detected 23.3% (284 of 1220) of distant recurrences (76.7%, 936 of 1220 by signs and/or symptoms). Based on propensity-weighted multivariable Cox proportional hazards models, patients with asymptomatic imaging compared with sign and/or symptom detected recurrences had a lower risk of death if estrogen receptor (ER) and progesterone receptor (PR) negative, HER2 negative (triple negative; hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.54 to 0.99), or HER2 positive (HR = 0.51, 95% CI = 0.33 to 0.80). No association was observed for ER- or PR-positive, HER2-negative (HR = 1.14, 95% CI = 0.91 to 1.44) cancers. Conclusions Recurrence detection by asymptomatic imaging compared with signs and/or symptoms was associated with lower risk of death for triple-negative and HER2-positive, but not ER- or PR-positive, HER2-negative cancers. A randomized trial is warranted to evaluate imaging surveillance for metastases results in these subgroups.

中文翻译：

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II-III 期乳腺癌的监测成像与症状复发检测和生存率 (AFT-01)

摘要 背景局部乳腺癌治疗后的随访指南建议仅在患者出现体征和/或症状时才对远处转移进行影像学检查。然而，指南尚未更新以反映影像学、全身治疗或对生物亚型的理解方面的进展。我们评估了远处复发检测模式与生存之间的关联。 方法在这项观察性研究中，选择了 2006-2007 年患有 II-III 期乳腺癌并随访至 2016 年的分期分层随机样本，其中包括来自 1217 个癌症委员会设施的最多 10 名女性 (n = 10 076) 。解释变量是复发检测模式（无症状影像学与体征和/或症状）。结果是从最初诊断出癌症到死亡的时间。登记员提取扫描类型、意图（与癌症相关与否、无症状监测与非癌症相关）和复发情况。数据与每位患者的国家癌症数据库记录合并。 结果监测成像检测到 23.3%（1220 人中的 284 人）的远处复发（根据体征和/或症状，76.7%，1220 人中的 936 人）。根据倾向加权多变量 Cox 比例风险模型，如果雌激素受体 (ER) 和孕激素受体 (PR) 阴性、HER2 阴性（三阴性；风险比 [HR] = 0.73，95% 置信区间 [CI] = 0.54 至 0.99），或 HER2 阳性（HR = 0.51，95% CI = 0.33 至 0.80）。未观察到 ER 或 PR 阳性、HER2 阴性（HR = 1.14，95% CI = 0.91 至 1.44）癌症之间的关联。 结论与体征和/或症状相比，通过无症状影像学检测复发与三阴性和 HER2 阳性癌症的死亡风险较低相关，但与 ER 或 PR 阳性、HER2 阴性癌症的死亡风险无关。有必要进行随机试验来评估这些亚组中转移结果的影像学监测。