Locally advanced breast cancer in Saudi Arabia: high frequency of stage III in a young population

In the Kingdom of Saudi Arabia (KSA), breast cancer constitutes 18% of all cancers in Saudi women. Whilst locally advanced breast cancer disease is un usual in Western countries, it constitutes more than 40% of all non-metasta tic breast cancer in KSA. The relative frequency of locally advanced diseas e among our breast cancer population and the lack of a uniform consensus in the literature about its optimal management have prompted this retrospecti ve analysis of the medical records of patients with Stage III breast cancer patients seen at King Faisal Specialist Hospital and Research Center betwe en 1981 and 1991. In all, 315 patients were identified. Their median age +/ - SD was 46 +/- 11.6 years which is distinctly different from the 60-65 yea rs median age in industrial Western nations. Most patients were younger tha n 50 years (64%) and premenopausal (62%). Patients were approximately equal ly divided between Stage IIIA and Stage III B. Patients received multimodal ity treatment, including surgery, adjuvant chemotherapy, tamoxifen, and adj uvant radiotherapy. Sixty-one patients were excluded from survival analysis as they were considered lost to follow-up. Of the remaining 254 patients, 73 (29%) were alive and disease free, and 18 patients (7%) were alive but w ith evidence of the disease. The remaining 163 (64%) had died from breast c ancer or its related complications. Their median overall survival (OS) was 54 months, (95% CI, 27 to 121 months) and the median progression-free survi val (PFS) was 28.8 months (95% CI, 14.2 to 113 months). Cox proportional ha zard model identified Stage III B and the number of positive axillary lymph nodes as poor predictors of OS and PFS. Radiotherapy was the only adjuvant modality that affected survival favourably. The prognosis of patients with Stage III disease remains poor despite the use of a multimodality approach . The overall young age of our patients may have contributed to the poor ou tcome. Moreover, the adverse effect of Stage III B disease (as compared wit h Stage IIIA) and axillary nodal status was evident. Whilst the favourable effect of radiotherapy on survival was demonstrated, the lack of independen t efficacy of other modalities (adjuvant chemotherapy and tamoxifen) or the apparent deleterious effect of neoadjuvant chemotherapy should be addresse d with discretion in such retrospective analysis. Optimal management of pat ients with locally advanced breast cancer disease should be appraised in we ll designed, prospective, randomised studies.