What does this research mean for the field?

Intermediate-risk HR-positive/HER2-negative early breast cancer patients have a 10-year invasive disease-free survival of 73.8% and overall survival of 84.6%, with relapse rates that increase steadily over time rather than peaking at specific intervals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to assess long-term outcomes in intermediate-risk hormone receptor-positive/HER2-negative early breast cancer patients.

May 28, 2026Open Access

Outcomes of Hormone receptor-positive/HER2-negative early breast cancer patients by risk of recurrence groups focusing on the intermediate-risk group: Retrospective analysis from GEICAM studies

Key Points

This study aims to assess long-term outcomes in intermediate-risk hormone receptor-positive/HER2-negative early breast cancer patients.
Retrospective analysis of 8,825 patients from 5 GEICAM trials and El Álamo IV registry.
Patients categorized into high-risk, intermediate-risk, and low-risk cohorts based on clinical parameters.
Median follow-up duration was 10.7 years.
10-year invasive disease-free survival (iDFS) in intermediate-risk cohort was 73.8%.
10-year overall survival (OS) for intermediate-risk was 84.6%.
Invasive relapse and distant relapse rates increased steadily in the intermediate-risk cohort.

Abstract

PURPOSE: Endocrine therapy (ET) with or without abemaciclib/ribociclib is the current standard for intermediate- and high-risk hormone receptor (HR)-positive/HER2-negative early breast cancer (EBC) patients. The NATALEE trial showed that adding 3 years of ribociclib to ET improves the 4-year invasive Disease-Free Survival (iDFS) by 4.9% compared with ET alone. Real world data on long-term risk of relapse is crucial when taking decisions about the prescription of new adjuvant drugs. METHODS: This is a retrospective analysis of 8,825 HR-positive/HER2-negative EBC patients recruited from 5 adjuvant GEICAM trials enrolled from 1999 to 2010 and El Álamo IV registry (diagnosed between 2002 and 2005). To estimate their long-term outcomes, patients were grouped into 3 cohorts: cohort 1 (high-risk, stage III); cohort 2 (intermediate-risk, T0-2N1, T3N0 or T2N0 and either histological grade (G)3, or GX/G2 with Ki-67 ≥ 20%); and cohort 3 (low-risk, stage I and T2N0 and either G1, or GX/G2 with Ki-67 < 20%). RESULTS: The distribution was 20.0% of patients in cohort 1, 36.0% in cohort 2 and 44.0% in cohort 3. With a median follow-up of 10.7 years, the 10-year iDFS were 53.8%, 73.8% and 84.0%, 10-y distant Disease-Free Survival were 56.3%, 77.3% and 87.8%, and 10-year overall survival (OS) were 66.7%, 84.6% and 91.9%, in cohorts 1, 2 and 3 respectively. In cohort 1, invasive relapse rate (IRR) and distant relapse rate (DDR) had a peak in years 2-3 and a second peak in year 7, while in cohorts 2 and 3 the rates increased steadily (higher at all time-points in cohort 2). In cohort 1, death rate (DR) had a soft peak in years 3-4 and years 7-8 while in cohorts 2 and 3 they increased steadily (also higher at all time-points in cohort 2). CONCLUSIONS: Intermediate-risk patients have a 10-year iDFS of 73.8%, and 10-year OS of 84.6%. The IRR, DDR and DR increased steadily in cohort 2 (as in cohort 3), in contrast to cohort 1. Further follow-up of the NATALEE trial is needed to determine the true benefit of adjuvant ribociclib in intermediate-risk patients and to decide the best ET strategy for these patients. Trial registration number ClinTrials.gov: GEICAM/9805: NCT00121992 (Study Registration Date: 2005-07-18); GEICAM/9906: NCT00129922 (Study Registration Date: 2005-08-10); GEICAM/2003-02: NCT00129389 (Study Registration Date: 2005-08-10); GEICAM/ 2003-10: NCT00129935 (Study Registration Date: 2005-08-11) and GEICAM/ 2006-10: NCT00543127 (Study Registration Date: 2007-10-11).

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