Overall survival of patients with breast cancer in routine clinical practice: data from the N.O. Napalkov cancer centre, 2017–2025

Aim. To assess overall survival in patients with breast cancer treated in routine clinical practice.
Materials and methods. This retrospective cohort study included 17 317 patients with stage I–IV invasive breast cancer 
and a defined molecular subtype who were treated at the N.P. Napalkov Cancer Centre in 2017–2025. Treatment followed 
the RUSSCO practical recommendations in 2017–2021 and the applicable Russian Ministry of Health clinical guidelines 
from January 2022. Vital status was ascertained through complete linkage with the federal register of insured persons 
(data cut-off: 13 August 2026). Survival was estimated using the Kaplan – Meier method with left truncation; multivariable 
analysis was performed using a Cox proportional hazards model.
Results. The median follow-up was 52.3 months; 3 767 patients (21.8%) died. Five-year overall survival was 89.9, 81.7, 
61.9, and 31.3% for stages I, II, III, and IV, respectively; by molecular subtype, it was 81.8% for luminal A, 79.9%for luminal 
B HER2-positive, 73.2% for HER2-positive non-luminal, 70.6% for luminal B HER2-negative, and 60.6% for triple-negative 
breast cancer. Stage, triple-negative (HR 2.30; 95% CI 2.09–2.53) and luminal B HER2-negative subtypes (HR 1.47; 95% CI 
1.36–1.60), and age (HR 1.37 per 10-year increase) were independently associated with a higher risk of death. Median survival 
from the detection of distant metastases was 37.0 months in de novo metastatic disease and 28.2 months in recurrent 
disease after primary treatment for localized cancer (HR 1.25; 95% CI 1.15–1.36).
Conclusion. Overall survival differed by stage and molecular subtype. The relative effect of subtype was similar across 
stages I–III, whereas absolute differences increased with disease extent. The proportion of patients with stage I–II disease 
increased from 63.9 to 75.7% (p<0.001), while the proportion with de novo metastatic disease remained unchanged. The 
adjusted risk of death decreased with each successive diagnosis year in the overall cohort (HR 0.950 per year; p<0.001) 
and in all subtypes except triple-negative breast cancer; in the metastatic population, a similar trend was observed only in 
HER2-positive disease (HR 0.946 per year; p=0.016).