Wangchinda Pattaraporn, Ithimakin Suthinee
Division of Medical Oncology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Chalermprakiat Building, 13th floor, Siriraj Hospital, 2 Wanglang Rd, Bangkoknoi, Bangkok, 10700, Thailand.
World J Surg Oncol. 2016 Aug 24;14(1):223. doi: 10.1186/s12957-016-0988-0.
Occasionally, 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.
We 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.
We 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.
ER(+)/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.
偶尔，乳腺癌会在初始治疗5年多后复发，有时这类晚期复发患者的病情极具侵袭性。本研究调查了可手术乳腺癌5年以上复发的预测因素。
我们回顾性分析了诗里拉吉医院治疗的复发性乳腺癌患者的数据。患者被分为复发时间长于或短于5年的两组。在总体人群和管腔亚组中分析预测晚期复发的因素。还记录了复发模式、生物标志物变化以及首次复发后疾病进展时间。
我们纳入了2005年至2013年间乳腺癌复发的300名女性，其中180人在诊断后5年内复发，120人在5年后复发（复发的中位时间：45.43个月；范围：4.4 - 250.3个月）。大于2 cm的肿瘤、淋巴结转移和高核分级与早期复发相关。雌激素受体阳性、孕激素受体阳性和HER2阴性疾病预测晚期复发。几乎所有管腔肿瘤晚期复发患者的雌激素受体（ER(+)）水平都很高（≥50%）且为HER2阴性疾病。肝脏和脑是最常见的早期复发部位。生物标志物在复发时无显著变化。
ER(+)/PR(+)和HER2(-)患者5年后复发风险更高，尤其是雌激素受体水平高且核分级低的患者。肿瘤较大且有淋巴结转移的患者早期复发风险更高。
