Abstract
BACKGROUND: Outcomes of early breast cancer in African women are currently not well defined. AIM: To analyze survival outcomes and prognostic factors in Moroccan women with operable breast cancer treated with multimodal therapies. METHODS: We retrospectively analyzed the data of a large cohort of 400 patients diagnosed with nonmetastatic breast cancer who completed surgery, chemotherapy, and radiotherapy at the National Institute of Oncology in Rabat, from January 2001 to December 2003. RESULTS: The mean age at diagnosis was 45 years (range: 22-91 years). Surgery was performed in all cases: Mastectomy in 86% and breast-conserving surgery in 14%. Most tumors (> 87%) were classified as pathologic T2 stage or higher, and axillary lymph nodes were involved in 75.5% of cases. Ninety-five percent of patients completed six cycles of adjuvant chemotherapy, and all received radiotherapy. At a median follow-up of 74.5 months, the 5-year overall survival (OS) was 82.1% [95% confidence interval (CI): 78.1-86.3], and the 5-year disease-free survival was 78.1% (95%CI: 73.8-82.6). In univariate analysis, negative nodal status [pN- vs pN+, hazard ratio (HR) = 0.34, 95%CI: 0.16-0.75; P = 0.007] and lower American Joint Committee on Cancer (AJCC) stage (I-II vs III, HR = 0.29, 95%CI: 0.16-0.52; P < 0.001) were significantly associated with better OS. In multivariate analysis, AJCC stage I-II vs stage III remained the strongest predictor of improved OS (HR = 0.32, 95%CI: 0.15-0.67; P = 0.002), followed by treatment with anthracyclines vs cyclophosphamide, methotrexate, fluorouracil (CMF; HR = 0.58, 95%CI: 0.35-0.94; P = 0.027). CONCLUSION: Moroccan women with early breast cancer exhibited more aggressive disease compared to women in high-income countries. AJCC stage III was the strongest predictor of poorer OS, followed by chemotherapy regimen (CMF vs anthracycline). A multimodal treatment approach, including surgery, systemic therapy, and radiotherapy, is essential to improve breast cancer outcomes.