Prognostic Factors Affecting Local Recurrence and Systemic Metastasis in Early Stage Breast Cancer

Abstract

Objective: Breast cancer is the most common cancer in women. Mortality in breast cancer is associated with recurrence and metastases. The aim of this study was to determine the causes of local recurrence and metastasis in operated early stage breast cancer. Material and Methods: The files of the patients diagnosed with operated early stage breast cancer followed up at Dicle University Medical Faculty Medical Oncology Department between 2001-2010 were analyzed retrospectively. The group of patients with recurrence was referred to as the relapse-metastasis group and the other patients were called the remission group. Between these two groups, age, sex, tumor histology, size, presence of lymphovascular invasion, tumor grade molecular properties such as, ER, PR, HER, staging studies; time characteristics, surgical characteristics, time between surgery-chemotherapy and surgery-radiotherapy; The relapse-metastasis group and the remission group were compared in terms of chemotherapy. SPSS 22 was used for statistical analysis. p<0.05 was considered significant. Results: 479 patients were included in the study. The number of patients in the remission and relapse-metastasis group was 343 and 136, respectively. Tumor diameter was 3.33 cm in the remission group and 4.58 cm in the relapse-metastasis group, and the difference was statistically significant (p<0.01). The percentage of involvement of more than 4 lymph nodes were 30.45% and 55.7% in the remission and relapse-metastasis groups, respectively (p <0.01). The percentage of the lymphovascular invasions were remission group and relapse-metastasis group 46.4% and 80% respectively. The percentage of patients with surgery-chemotherapy time> 1 month was 9.7% and 24% in the remission and relapse-metastasis group, respectively. In remission group 30.9%; relapse-metastasis group 47.7% of the patients had incomplete staging at the time of diagnosis. Conclusion: The factors determining the recurrence in patients with operated early stage breast cancer were tumor size, number of lymph node involvement, incomplete staging at the time of diagnosis, start chemotherapy later than 1 month.

Keywords

• early stage breast cancer,recurrence,metastasis

References

1. 1. Breast cancer facts & figures 2005–2006. Atlanta, American Cancer Society Inc., 2006 [Internet] 2009 Available from: http://www.cancer.org/downloads/ STT/CAFF2005BrF.pdf, accessed 2009).
2. 2. Anderson WF, Katki HA, Rosenberg PS. Incidence of breast cancer in the United States: current and future trends. J Natl Cancer Inst. 2011;103(18):1397–1402.
3. 3. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al; Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353(17):1784-1792.
4. 4. https://hsgm.saglik.gov.tr/depo/birimler/kanserdb/istatistik/2010_Yili_Turkiye_Kanser_istatistikleri.pdf [Internet] 2010.
5. 5. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687-1717.
6. 6. Koscielny S, Tubiana M, Lê MG, Valleron AJ, Mouriesse H, Contesso G, et al. Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination. Br J Cancer. 1984;49(6):709-715.
7. 7. Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet. 1998;352(9132):930-942.
8. 8. Rosen PP, Groshen S, Kinne DW, Norton L. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol. 1993;11(11):2090-2100.

9. 9. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-187.
10. 10. Galea, M. H., Blamey, R. W., Elston, C. E. & Ellis, I. O. The Nottingham Prognostic Index in primary breast cancer. Breast Cancer Res. Treat. 1992;22(3):207–219.
11. 11. Shannon C, Ashley S, Smith IE. Does timing of adjuvant chemotherapy for early breast cancer influence survival? J Clin Oncol 2003;21:3792-3797.
12. 12. Cody HS., 3rd Current surgical management of breast cancer. Curr Opin Obstet Gynecol 2002;14:45-52.