Evaluation of clinical features and risk factors related to late recurrence (>5 years) in patients with breast cancer

Late breast cancer recurrence

Abstract

Background/Aim: Over the years, disease-free survival (DFS) has been considerably prolonged with effective treatments in resectable breast cancer patients. However, a limited number of studies evaluating the predictive and prognostic factors of the disease in breast cancer patients who develop late recurrence are available. In this respect, we investigated clinicopathological features and risk factors affecting the survival of patients who developed breast cancer recurrence (BCR) after 60 months (late BCR).

Methods: In this retrospective cohort study, clinicopathological features and survival outcomes of 45 late BCR patients were evaluated. The demographic and medical data of the patients were obtained from the retrospective registry system of our center. Statistical analyses were performed to determine the risk factors affecting DFS.

Results: The median age of the cohort was 49 (24–78) years. Twenty-three postmenopausal patients were included in the study, and the mean age of menopause was 50 (43–55) years. Fourteen (31.1%) patients were stage 3 at diagnosis. In the adjuvant period, 80% of the patients underwent radiotherapy, and 79.5% underwent chemotherapy. The mean duration of adjuvant hormone therapy was 64 (69–129) months. Adjuvant ovarian suppression therapy was applied to 14 patients. The three most common sites of recurrence were bones (57.8%), locoregional (26.7%), and distant lymph nodes (26.7%). The median DFS of the cohort was 116.9 (3.7) months (109.6–124.1 months). Disease-related deaths occurred in only five patients, and the median overall survival (OS) could not be achieved. Based on a log-rank analysis, the median DFS was longer in patients whose adjuvant hormone therapy duration was 5–10 years and in those with bone or lymph node recurrence (P = 0.025 and P = 0.001, respectively). DFS was significantly shorter in patients with liver metastases (P = 0.005). Based on a chi-squared analysis, bone and lymph node metastases were higher in luminal A-like group (P = 0.030), and liver metastasis was lower (P = 0.039). Luminal biology did not affect late BCR (P = 0.075).

Conclusions: Prolonged adjuvant hormone therapy (5–10 years) delays breast cancer recurrence. However, luminal features are insufficient to predict recurrence as the recurrence period increases. In addition, different sites of metastases are associated with long-term survival and luminal subgroups.