Wirsching Psychosocial Risk Scale (WPRS) Versus Outcome in Patients With Breast Disease and Breast Cancer: A Prospective 25-year Follow-up Study in Patients With Breast Cancer Symptoms.

Background/Aim This study evaluated whether Wirsching Psychosocial Risk (WPR) scale for measuring the severity of psychosocial risk (PR) factors can predict the long-term outcomes in patients having breast carcinoma (BC) symptoms. Patients and Methods A totalof 115 patients with BC symptoms completed the WPR scale and associations between WPR scale and long-term outcome were analyzed using survival models. Results The WPRS scores correlated to Beck Depression Inventory (BDI) (r=0.382, p<0.001), to Montgomery-Asberg Depression Rating Scale(MADRS) (r=0.517, p<0.001), to Forsen inventory (FI) during 0-2 years (r=0.392, p<0.001) and FI 2-6 years (r=0.397, p<0.001) prodromal periods and to State-Trait Anxiety inventory (STAI) (r=0.131, p=0.164) levels.In the Cox model, the WPR scale predicted the 25-year relapse-free survival (RFS) in patients with BC [hazard ratio (HR)=1.76, p=0.197] and the WPR scale predicted 25-year overall survival (OS) in women with BC symptoms (HR=2.31, p=0.019) and women with BC (HR=2.12, p=0.09). In the Kaplan-Meier survival analysis by the log-rank test, the 25-year relapse rate differed between low WPRS score (<21) versus the high WPRS score (≥21) in patients with BC (37.5% versus 20%, log-rank p-value=0.195). Also, the low WPRS score (<21) was a favorable predictor of RFS [HR=1.50, 95% confidence interval (CI)=0.80-2.99, p=0.199] in the patients with BC symptoms. The 25-year OS rate differed significantly between low WPRS score (<21) versus high WPRS score (≥21) patients with BC symptoms (74.4% versus 53.0%, log-rank p-value=0.016). A similar pattern was seen in patients with BC as the WPRS score predicted 25-year OS in women with BC (45.8% versus 20.0%, log-rank p-value=0.088). Conclusion The studies assessing the impact of PR factors on outcome of patients with BC symptoms have not reported WPRS levels. In the present study, a 25-year follow-up of patients with BC symptoms enables us to detect the 25-year outcome and to assess the RFS and OS versus WPRS approach using Kaplan-Meier and Cox proportional hazard models. The study showed that the PR variables detected with the WPR scale significantly correlate to the 25-year OS in patients with BC and 25-year OS in patients with BC symptoms. Therefore, the use of WPRS inventory detecting PR factors should be considered as a useful part of the diagnostic protocol of patients with BC symptoms.