Analysis The Relationship Between Locoregional Recurrence And Distant Metastasis In Breast Cancer After Mastectomy

BackgroundBreast cancer is still the main cause of death for female in the worldwide, since diagnosis ofbreast cancer, the risk of locoregional recuuence (LRR) and diatant metastasi will accompany with patientsfor life. A LRR was defined as any reappearance of cancer in the ipsilateral chest wall or soft tissueoverlaying the ipsilateral; or cancer spread to the ipsilateral axillary nodes; or caner spread to the ipsilateralsupra/infraclaviculary nodes. LRR is a serious event for breast cancer patients, Some patients may appeardistant metastasis in a very short time, but there are alse parts of patients with good prognosis. Therelationship between LRR and distant metastasis has a huge impact on the formulation of treatmentstrategies, so it is necessary to identify patients with LRR in whom distant metastasis alse developed.ObjectiveTo identify patients with locoregional recurrence (LRR) in whom distant metastasis alsedeveloped, in order to give different treatments according to different clinical LRR subtypes.MethodsWe identified1876female patients who underwent mastectomy for invasive cancer in HenanTumor Hospital from2000.1to2005.12, through immunohistochemistry and genetic testing to detct theER、PR、Ki-67、HER-2of the LRR patients, predictive factors for distant metastasis in patients who presentwith LRR were determined by univariate and multivariate analyses, through Kaplan-Meier method tocalculate the survival of different types of LRR patients.ResultsThe median follow-up was74months, and98(5.2%) patients experienced a LRR in theirfollow-up period. Twenty-seven (1.4%) had synchronous distant metastases, distant recurrence developedin thirty-four (1.8%) during the follow-up period, thirty-seven patients with LRR (2.0%) remained free ofdistant disease during the study period. In the multivariate analysis, HER-2positive type(HER-2positive vsluminal-A；p <0.05；Hazard Ratio [HR]，5.3；95%Confidence Interval [CI]，1.1-25.4)、basal-like type(basal-like vs luminal-A；p <0.05；HR，3.7；95%CI，1.1-12.7)、pathological stage III(stage III vsstage I-II；p <0.001；HR,9.7；95%CI,3.1-30.4)、recurrence interval time(≤2years vs>2years；p <0.001；HR，10.7；95%CI，3.5-32.4) were the independent prognostic factors for LRR patients who are likely tohave distant metastases. Through Kaplan-Meier method the5-year survival rate of the patients who didn’texperienced a LRR in their follow-up period is96%, the5-year survival rate of the simple LRR patients is81%, the5-year survival rate of LRR patients who are likely to have distant metastases is50%.Conclusions1. For the high risk LRR patients,HER-2positive type breast cancer、basal-like type breastcancer、pathological stage III、recurrence interval time are the important risk factors to lead distantmetastasis.2. For the high risk LRR patients whose recurrence interval time<2years,aggressivemultimodality therapy is warranted to improve prognosis.