Abstract
BackgroundOccasionally, breast cancer relapses more than 5 years after initial treatment, sometimes with highly aggressive disease in such late-recurring patients. This study investigated predictors of recurrence after more than 5 years in operable breast cancer.MethodsWe retrospectively analyzed data from patients with recurrent breast cancer treated at Siriraj Hospital. Patients were divided into those whose relapse times were longer or shorter than 5 years. Factors that predicted late recurrence were analyzed in both the overall population and the luminal subgroup. Patterns of relapse, changes in biomarkers, and time to disease progression after first relapse were also recorded.ResultsWe included 300 women whose breast cancers recurred between 2005 and 2013, of whom 180 had recurrence within 5 years of diagnosis and 120 later than 5 years (median time to recurrence: 45.43 months; range: 4.4–250.3 months). Tumors larger than 2 cm, lymph node metastasis, and high nuclear grade were related with early recurrence. Estrogen receptor-positive, progesterone receptor-positive, and HER2− disease predicted late recurrence. Almost all late-relapsing patients with luminal tumors had high estrogen receptor (ER+) titers (≥50 %) and HER2− disease. Liver and brain were the most common early recurrence sites. Biomarkers did not significantly change by time of recurrence.ConclusionsER+/PR+ and HER2− patients have higher risk of recurrence later than 5 years, especially in patients with high ER titer and low nuclear grade. Larger and node-positive tumors had higher risk of early recurrence.
Highlights
Breast cancer relapses more than 5 years after initial treatment, sometimes with highly aggressive disease in such late-recurring patients
Previous studies reported that high-bulk disease, high proliferative index, and Human epidermal receptor 2 (HER2)-positive malignancies corresponded to recurrence earlier than 10 years, whereas progesterone receptor-positive (PR+) disease was associated with relapse later than 10 years [1, 2]
Some patients develop rapid and extensive metastasis during the follow-up intervals; a few of these patients cannot undergo chemotherapy owing to organ dysfunction or lower performance status as a result of widespread metastasis
Summary
Breast cancer relapses more than 5 years after initial treatment, sometimes with highly aggressive disease in such late-recurring patients. Adjuvant systemic therapies, including chemotherapy, hormonal treatment, and anti-HER2 (human epidermal receptor) agents have been proven to reduce disease recurrence and prolong survival. Most relapses occur during the first 5 years after diagnosis, late recurrence has been reported, especially in luminal breast cancer. Breast cancer may recur 5–10 years after initial treatment. Previous studies reported that high-bulk disease, high proliferative index, and HER2-positive malignancies corresponded to recurrence earlier than 10 years, whereas progesterone receptor-positive (PR+) disease was associated with relapse later than 10 years [1, 2]. Follow-up visits are usually scheduled annually for patients who have had Wangchinda and Ithimakin World Journal of Surgical Oncology (2016) 14:223 five disease-free years or who have completed hormonal treatment. Some patients develop rapid and extensive metastasis during the follow-up intervals; a few of these patients cannot undergo chemotherapy owing to organ dysfunction or lower performance status as a result of widespread metastasis
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