Recurrence and death from breast cancer after complete treatments: an experience from hospitals in Northern Thailand (original) (raw)
Related papers
Iranian Journal of Cancer Prevention
Background: Breast cancer treatment success depends upon prolonging survival with effective treatment, and constant monitoring of recurrence. Survival rate can well be improved by better understanding of prognostic factors, preventive measures, and effective treatments together with follow-up and post-treatment care. Objectives: This study is aimed to know prognostic factors effective in recurrence and death in Iranian breast cancer patients. Methods: This is a retrospective study conducted by reviewing data acquired from 1604 female breast cancer patients who were admitted to Cancer Research Center at Shahid Beheshti University of Medical Sciences between October, 1982 and March, 2014. During the follow-up, after diagnosis, 313 patients experienced recurrence then were classified into two groups: early recurrence, less than 1 year and late recurrence after 5 years. We analyzed prognostic factors of recurrence in each groups and evaluated effective factors of death in this patients. Results: Median age of patients at diagnosis was 50 years. Median follow up time was 4.33 years (range: 0.005-24.9 years). Of these patients, 210 (67.09 %) and 76 (24.28%), developed distant and loco-regional recurrence. Among 313 patients, 62 (21/60%) and 69 (24/04%) had early and late recurrence. In the univariate analysis, tumor grade, stage of disease, ER and PR status, axillary lymph node involvement and lymph vascular invasion were the prognostic factors affecting recurrence in patients, but in the multivariate analysis, ER/PR status was the most important independent prognostic factor affecting the early recurrence and stage of disease were prognostic factors in late recurrence. In all of the recurrent patients, 56.86% (178 individuals) survived and 43.13% (135 individuals) died at the end of follow-up period. The most important factors of death were histologic grade, disease free survival time, site of recurrence and age of disease. Conclusions: Biologic marker, estrogen and progesterone receptors status, had most influence in early recurrence, unlike late recurrence, stage of disease had a more important role. However, lymph vascular invasion has been an effective factor either in early or late recurrence. As a result of studying effective factors in death of these patients, recurrence site, DFS, pathologic grade and patients' age at the time of recurrence came to be effective. Knowing more about affecting factors on recurrence and the death of patients with recurrence, one can try to enhance survival and quality of life in patients by adopting more effective treatments.
Cancer, 2002
BACKGROUNDThe authors analyzed the outcome of patients with early-stage breast carcinoma after an isolated local recurrence, taking into account initial tumor characteristics and the type of initial treatment and local salvage treatment.The authors analyzed the outcome of patients with early-stage breast carcinoma after an isolated local recurrence, taking into account initial tumor characteristics and the type of initial treatment and local salvage treatment.METHODSOne hundred five patients were studied who presented with a breast tumor measuring ≤ 25 mm and who subsequently developed an isolated local recurrence (breast or chest wall) as the first tumor event. A second series included 335 patients who developed distant metastases as the first event. Cox models that took into account potential prognostic factors were used to estimate the risk of death. First, survival rates were compared after an isolated local recurrence and after a diagnosis of distant metastases; and, second, effects of initial treatments and local or systemic treatments of local recurrences were analyzed.One hundred five patients were studied who presented with a breast tumor measuring ≤ 25 mm and who subsequently developed an isolated local recurrence (breast or chest wall) as the first tumor event. A second series included 335 patients who developed distant metastases as the first event. Cox models that took into account potential prognostic factors were used to estimate the risk of death. First, survival rates were compared after an isolated local recurrence and after a diagnosis of distant metastases; and, second, effects of initial treatments and local or systemic treatments of local recurrences were analyzed.RESULTSThe 10-year survival rate was 56% (95% confidence interval, 45–65%) after an isolated local recurrence compared with 9% (95% confidence interval, 7–13%) after distant metastasis as the first event. Three independent prognostic factors for the risk of death after local recurrence were identified: histologic tumor grade, patient age at the time of diagnosis with the primary tumor, and disease free interval until recurrence. The type of initial treatment and local salvage treatment did not influence the risk of death. Systemic treatments of local recurrence had different effects according to the patient's menopausal status. In premenopausal patients, ovarian suppression and chemotherapy significantly decreased the risk of death. In postmenopausal women, systemic treatments did not affect the risk of death.The 10-year survival rate was 56% (95% confidence interval, 45–65%) after an isolated local recurrence compared with 9% (95% confidence interval, 7–13%) after distant metastasis as the first event. Three independent prognostic factors for the risk of death after local recurrence were identified: histologic tumor grade, patient age at the time of diagnosis with the primary tumor, and disease free interval until recurrence. The type of initial treatment and local salvage treatment did not influence the risk of death. Systemic treatments of local recurrence had different effects according to the patient's menopausal status. In premenopausal patients, ovarian suppression and chemotherapy significantly decreased the risk of death. In postmenopausal women, systemic treatments did not affect the risk of death.CONCLUSIONSIsolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis. The outcome of patients is not affected by the type of initial treatment or local salvage treatment. After a local recurrence, ovarian suppression or chemotherapy had a beneficial effect in premenopausal patients. Cancer 2002; 94:2813–20. © 2002 American Cancer Society.DOI 10.1002/cncr.10572Isolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis. The outcome of patients is not affected by the type of initial treatment or local salvage treatment. After a local recurrence, ovarian suppression or chemotherapy had a beneficial effect in premenopausal patients. Cancer 2002; 94:2813–20. © 2002 American Cancer Society.DOI 10.1002/cncr.10572
Researchlocoregional recurrence and recurrence-free survival in breast cancer patients
2010
Background: One essential outcome after breast cancer treatment is recurrence of the disease. Treatment decision is based on assessment of prognostic factors of breast cancer recurrence. This study was to investigate the prognostic factors for postmastectomy locoregional recurrence (LRR) and survival in those patients. Methods: 114 patients undergoing mastectomy and adjuvant radiotherapy in Cancer Institute of Tehran University of Medical Sciences were retrospectively reviewed between 1996 and 2008. All cases were followed up after initial treatment of patients with breast cancer via regular visit (annually) for discovering the LRR. Cumulative recurrence free survival (RFS) was determined using the Kaplan-Meier method, with univariate comparisons between groups through the log-rank test. The Cox proportional hazards model was used for multivariate analysis. Result: The median follow up time was 84 months (range 2-140). Twenty-three (20.2%) patients developed LRR. Cumulative RFS rate...
The relationship between local recurrence and death in early-stage breast cancer
Breast cancer research and treatment, 2015
To examine the relationship between local recurrence and breast cancer mortality in women with early-stage breast cancer. We studied 1675 women with stage 0 (DCIS), stage I or stage II breast cancer who were treated with breast-conserving surgery at Women's College Hospital between 1987 and 2009. For each patient, we obtained information on age at diagnosis, tumour size, lymph node status, tumour grade, lymphovascular invasion, oestrogen receptor status, progesterone receptor status, HER2 status and treatments received (radiotherapy, chemotherapy and tamoxifen). Patients were followed from the date of diagnosis until local recurrence, death from breast cancer or the date of last follow-up. We used the Kaplan-Meier method to estimate 15-year local recurrence-free and breast cancer-specific survival rates for each stage at diagnosis. For each stage, the two rates were compared. After a mean follow-up of 13.1 years, 243 women (14.5 %) experienced a local recurrence and 281 women (1...
Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer
Breast Cancer Research and Treatment, 1997
The study evaluated prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983-85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen. If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5-11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.
Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial
Annals of surgical oncology, 2016
Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated. In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome. The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had no...
Clinical and Translational Oncology, 2015
Purpose In the literature, small number of study has addressed time of recurrence in breast cancer. We analyzed clinicopathological factors predicting early or late recurrence in breast cancer patients and also prognostic factors related with recurrence-free survival (RFS) in recurrent patients. Patients/methods We evaluated retrospectively 1980 breast cancer patients. Relapsed was defined as early if it was occured first 5 year of follow-up (Group 1) and late if it was occured after 5 years (Group 2). The clinicopathological factors were compared in respect of time of recurrence. The prognostic factors were evaluated using univariate and multivariate analyses. Results Recurrence wase detected in 141 patient during follow-up. Tumors recurred after 5 years more likely to have lower stage (p = 0.05), tumors without lymphovascular invasion (LVI) (p \ 0.001) and perineural invasion (PNI) (p = 0.01), and also HER2 negative (p \ 0.001). The median RFS time and 5 years RFS rates were 42.9 months and 31.9 %, respectively. LVI (p = 0.01), PNI (p = 0.03), HER2 (p = 0.003), progesterone receptor (PR) (p = 0.04), the presence of neoadjuvant chemotherapy (p = 0.003), adjuvant hormonotherapy (p = 0.05) were found to be related with RFS. Axillary lymph node metastasis (p = 0.05) and the presence of PNI (p = 0.009) were poor prognostic factors for early recurrent group. PRpositive tumors (p = 0.001) and luminal subtypes (p = 0.03) had instances of late recurrences significantly. Conclusions Clinicopathological factors predicting the recurrence time in breast cancer were important to modify adjuvant therapy.
Prognostic Factors Associated with Survival After Breast Cancer Recurrence
Acta Oncologica, 1991
Factors associated with disease-free interval after the primary treatment and survival after a recurrence of breast cancer were studied in 331 female breast cancer patients treated in 1976 ~ 1980. Within five years after the primary treatment. recurrence occurred in 131 patients. The observation time of these patients after recurrence was from few weeks to twelve years. Twenty-nine patients were alive at the end of the follow-up. The average disease-free time was 2 years. The clinical stage of the disease in this material was not significantly associated with the disease-free interval. The median survival time after recurrence was 2.7 years when only breast cancer related deaths were included. Survival was significantly better for patients with primarily stage I disease than for patients with primarily stage 11-IV disease. The size of the primary tumour was not significantly associated with survival after recurrence. The patients with loco-regional recurrence survived almost significantly better than those with distant recurrence. The disease-free time correlated positively with survival after a recurrence. The present study confirms the view that breast cancer includes several subgroups with a diferent type of clinical course.
Acta radiologica, 1984
The pattern of intercurrent mortality was studied in 3 857 cases of breast carcinoma diagnosed in Stockholm county during 1961-1963 and 1971-1973. The investigation was based on the recorded underlying and contributory causes of death in the Swedish Register of Causes of Death. The observed number of deaths due to various main disease groups was compared with the expected number calculated for an age-matched general population. A 21 per cent increase of intercurrent deaths was observed (95% confidence limits: 13-29%, p<O.OOl). Excess risks were found due to circulatory diseases, other tumours, 'accidents, suicides and injuries' and infectious diseases. The excess risk increased with time during follow-up and in the period 10 to 21 years it was 35 per cent (17-55%, p<O.OOl). These findings could be interpreted as an association between breast carcinoma and other diseases but might also to some extent have been caused by diagnostic errors or errors in the ascertainment of underlying versus contributory causes of death. It is concluded, however, that such possible errors are probably not a major source of bias in judging the mortality trend for the disease during the period encompassed by the investigation. This conclusion was based on the circumstance that the observed excess risks were of equal magnitude during the first ten years of follow-up in both the 1961-1963 and 1971-1973 series.