Background
Patients and methods
Characteristics | Number | Percent |
---|---|---|
Median age at diagnosis (years), range | 53 (31 - 83) | |
Total | 97 | |
Tumor size at the primary tumor | ||
≤ 2.0 cm | 51 | 52.6 |
2.0 cm < | 46 | 47.4 |
No. of positive nodes at the primary tumor | ||
0 | 46 | 47.4 |
1-3 | 27 | 27.8 |
4≤ | 21 | 21.6 |
Unknown | 3 | 3.1 |
Nuclear grade at the primary tumor | ||
1 | 16 | 16.5 |
2 | 50 | 51.5 |
3 | 19 | 19.6 |
Unknown | 12 | 2.1 |
Lymphatic invasion at the primary tumor | ||
0 | 27 | 27.8 |
1+ | 51 | 52.6 |
2+ | 17 | 17.5 |
Unknown | 2 | 2.1 |
ER at the primary tumor | ||
Positive | 62 | 63.9 |
Negative | 35 | 36.1 |
PgR at the primary tumor | ||
Positive | 55 | 56.7 |
Negative | 42 | 43.3 |
HER2 at the primary tumor | ||
Positive | 22 | 22.7 |
Negative | 75 | 77.3 |
p53 at the primary tumor | ||
Positive | 22 | 22.7 |
Negative | 75 | 77.3 |
Ki-67 index at the primary tumor | ||
Positive | 12 | 12.4 |
Negative | 85 | 87.6 |
DFI at recurrence | ||
< 2 years | 19 | 19.6 |
2-5 years | 33 | 34.0 |
5 years ≤ | 45 | 46.4 |
Sites of biopsied recurrence | ||
Chest wall | 39 | 40.2 |
In-breast | 34 | 35.1 |
Regional lymph node | 11 | 11.3 |
Lung | 3 | 3.1 |
Bone | 1 | 1.0 |
Brain | 3 | 3.1 |
Ovary | 3 | 3.1 |
Distant skin | 3 | 3.1 |
Distant metastasis at biopsy | ||
With | 33 | 34.0 |
Without | 64 | 66.0 |
Median Ki-67 value (%) at the primary tumor, range | 27.0 (1-91) | |
Median DFI (months), range | 57.4 (1-281) |
Histopathological Examination
Statistical Analysis
Results
1. Changes in positive rate due to relapse of biological markers
Biological Markers | Primary | Recurrence | p value |
---|---|---|---|
Positive rate (%) | |||
Estrogen Receptor | 62 (63.9) | 56 (57.7) | 0.46 |
Progesterone Receptor | 55 (56.7) | 42 (43.3) | 0.08 |
p53 | 22 (22.7) | 24 (24.7) | 0.87 |
HER2 | 22 (22.7) | 30 (30.9) | 0.26 |
Ki-67 Index | 12 (12.4) | 24 (24.7) | 0.012 |
(Ki-67: mean ± S.D.(%) | 29.1 ± 18.5% | 36.3 ± 21.0% | < 0.0001 ) |
2. Changes by category due to relapse of the biological markers
Marker | Decrease | Increase | % Change | p value | p value |
---|---|---|---|---|---|
primary → recurrence | * PgR | ** Ki-67 | |||
ER | + → - : 8 | - → + : 2 | 10/97 (10.3) | 0.009 | 0.03 |
PgR | + → - : 19 | - → + : 6 | 25/97 (25.8)* | 0.74 | |
p53 | + → - : 5 | - → + : 7 | 12/97 (12.4) | 0.028 | 0.09 |
HER2 | + → - : 3 | - → + : 11 | 14/97 (14.4) | 0.073 | 0.20 |
Ki-67 Index | + → - : 5 | - → + : 17 | 22/97 (22.6)** | 0.74 |
3. Changes in markers and DFI
Marker/DFI | Decrease | Increase | % Change | p |
---|---|---|---|---|
primary → recurrence | value | |||
ER | ||||
DFI < 2y | + → - : 2 | - → + : 1 | 3/19 (15.8) | |
2y < DFI < 5y | + → - : 4 | - → + : 1 | 5/33 (15.2) | *p = 0.045 |
DFI > 5y | + → - : 2 | - → + : 0 | 2/45(4.4) * | DFI < 5y |
PgR | ||||
DFI < 2y | + → - : 2 | - → + : 3 | 5/19 (26.3) | |
2y < DFI < 5y | + → - : 6 | - → + : 1 | 7/33 (21.2) | NS |
DFI > 5y | + → - : 11 | - → + : 2 | 13/45 (28.9) | (0.74) |
Ki-67 Index | ||||
DFI < 2y | + → - : 0 | - → + : 5 | 5/19 (26.3) | |
2y < DFI < 5y | + → - : 2 | - → + : 6 | 8/33 (24.2) | NS |
DFI > 5y | + → - : 3 | - → + : 6 | 9/45 (20.0) | (0.83) |
p53 | ||||
DFI < 2y | + → - : 1 | - → + : 0 | 1/19 (5.3) | |
2y < DFI < 5y | + → - : 3 | - → + : 2 | 5/33 (15.2) | NS |
DFI > 5y | + → - : 1 | - → + : 5 | 6/45 (13.3) | (0.56) |
HER2 | ||||
DFI < 2y | + → - : 0 | - → + : 1 | 1/19 (5.3) | |
2y < DFI < 5y | + → - : 1 | - → + : 6 | 7/33 (21.2) | NS |
DFI > 5y | + → - : 2 | - → + : 4 | 6/45 (13.3) | (0.28) |
4. Changes in molecular subtypes
Subtype/primary | No. of cases | Recurrent lesions | Discordance % | |||
---|---|---|---|---|---|---|
Luminal A | Luminal B | HER2 | TN | |||
Luminal A | 57 | 41 (71.2) | 8 (14.0) | 1 (1.8) | 7 (12.3) | 28.8 |
Luminal B | 6 | 2 (33.3) | 4 (66.7) | 33.3 | ||
HER2 | 16 | 0 | 2 (12.5) | 13 (81.3) | 1 (6.3) | 18.7 |
TN | 18 | 1 (5.6) | 0 | 2 (11.1) | 15 (83.3) | 16.7 |
Total | 97 | 44 | 14 | 16 | 23 | 24.7 |
5. Investigation of prognosis and predictive factors after recurrence
Univariate | analysis | Multivariate | |||
---|---|---|---|---|---|
Variables | Category | primary/recurrence | Relative risk | P value | P value |
Primary Tumor | |||||
Tumor size | 2.0 cm </≤2.0 cm | primary tumor | 0.98 | 0.93 | |
Nodal status | 0/1-3/4+ | primary tumor | 1.39 | 0.15 | |
Nuclear Grade | 1/2/3 | primary tumor | 1.55 | 0.22 | |
Ki-67 | 50%≤/< 50% | primary tumor | 5.67 | 0.0002 | 0.0006 |
ER | +/- | primary tumor | 0.49 | 0.07 | 0.09 |
PgR | +/- | primary tumor | 0.43 | 0.037 | 0.35 |
p53 | +/- | primary tumor | 2.18 | 0.058 | 0.11 |
HER2 | +/- | primary tumor | 0.9 | 0.82 | |
Recurrent Tumor | |||||
DFI | 5y≤/2y≤/< 2y | at recurrence | 0.73 | 0.22 | |
Ki-67 | 50%≤/< 50% | recurrent tumor | 2.88 | 0.009 | 0.32 |
ER | +/- | recurrent tumor | 0.36 | 0.013 | 0.51 |
PgR | +/- | recurrent tumor | 0.25 | 0.005 | 0.046 |
p53 | +/- | recurrent tumor | 1.78 | 0.16 | |
HER2 | +/- | recurrent tumor | 0.95 | 0.91 | |
Distant metastasis | +/- | at recurrence | 2.56 | 0.017 | 0.043 |