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Abstract
BackgroundRecent studies have shown that breast cancer subtype can change from the primary tumour to the recurrence. Discordance between primary and recurrent breast cancer has implications for further treatment and ultimately prognosis. The aim of the study was to determine the rate of change between primary and recurrence of breast cancer and to assess the impact of these changes on survival and potential treatment options.MethodsPatient demographics were collected on those who underwent surgery for breast cancer between 2001 and 2014 and had a recurrence with biopsy results and pathology scoring of both the primary and recurrence.ResultsOne hundred thirty two consecutive patients were included. There were 31 (23.5%) changes in subtype. Discordance occurred most frequently in luminal A breast cancer (n = 20), followed by triple negative (n = 4), luminal B (n = 3) and HER2 (n = 3). Patients who changed from luminal A to triple negative (n = 18) had a significantly worse post-recurrence survival (p < 0.05) with overall survival approaching significance (p = 0.064) compared to concordant luminal A cases (n = 46). Overall receptor discordance rates were: estrogen receptor 20.4% (n = 27), progesterone receptor 37.7% (n = 50) and HER2 3% (n = 4). Loss of estrogen receptor and progesterone receptor was more common than gain (21 vs. 6 (p = 0.04) and 44 vs. 6 (p = 0.01) respectively). Nine patients (6.8%) gained receptor status potentially impacting treatment options.ConclusionDiscordance in subtype and receptor status occurs between primary and recurrent breast cancer, ultimately affecting survival and potentially impacting treatment options.
Highlights
Recent studies have shown that breast cancer subtype can change from the primary tumour to the recurrence
Loco-regional recurrence after surgery was defined as the appearance of tumour in the ipsilateral chest wall or axillary, internal mammary or supraclavicular lymph nodes while distant recurrence was defined as recurrence to distant organs, confirmed by pathologists report
In summary, our study demonstrates the discordance of receptor and subtype between primary and recurrent breast cancer at our institution
Summary
Recent studies have shown that breast cancer subtype can change from the primary tumour to the recurrence. Discordance between primary and recurrent breast cancer has implications for further treatment and prognosis. The aim of the study was to determine the rate of change between primary and recurrence of breast cancer and to assess the impact of these changes on survival and potential treatment options. Risk of recurrence and outcome in breast cancer have conventionally been stratified according to the tumour size, grade, nodal status and especially tumour subtype [2]. Each subtype exhibits distinct prognoses, rates of recurrence and different treatment strategies [4]. Recurrence rates are influenced by the original breast cancer subtype, the specific therapy received and the response to the therapy [5]. Recurrent tumours have been have been assumed to be biologically similar
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