Evaluation of Factors Related to Late Recurrence - Later than 10 Years after the Initial Treatment - in Primary Breast Cancer

Nishimura, Reiki; Osako, Tomofumi; Nishiyama, Yasuyuki; Tashima, Rumiko; Nakano, Masahiro; Fujisue, Mamiko; Toyozumi, Yasuo; Arima, Nobuyuki

doi:10.1159/000353099

Cited by 9,355 publications

(48 citation statements)

References 72 publications

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“…In our institute, we adopted the cut-off points 20% and 50%, as previous studies revealed that they were instrumental as reliable points. Moreover, the median value was 20% in all the primary cases and 50% in the cases with the TN type (8,20,21).…”

Section: Discussionmentioning

confidence: 91%

“…Ibrahim et al (24) reported that patients with a Ki-67 index value of <20% exhibited a significantly higher post-recurrence survival compared to patients with a Ki-67 index value of ≥20%. Moreover, the bone, lung/pleura and chest wall were common sites of recurrence in the early recurrence group with highly proliferative tumors and liver metastasis was identified in 13.6% of the patients (21). In the late recurrence group exhibiting low proliferation, recurrence was more common in the lung/pleura and bone; however, liver and brain metastases were rarely encountered.…”

Section: Discussionmentioning

confidence: 93%

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Prognostic significance of Ki-67 index value at the primary breast tumor in recurrent breast cancer

Nishimura

Osako

Nishiyama

et al. 2014

Molecular and Clinical Oncology

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Abstract. The Ki-67 index value is a prognostic factor in primary breast cancer and is a proliferation marker that also distinguishes between luminal type A and type B breast cancer. Moreover, a change in Ki-67 index values due to treatment and recurrence is considered to be important in treating breast cancer. In this study, we investigated whether the baseline Ki-67 value in the primary tumor is useful as a prognostic factor following disease recurrence. Immunohistochemical analysis of the Ki-67 index was performed on 4,701 patients with primary breast cancer from 1987 until March, 2013. Among these patients, there were 666 consecutive cases exhibiting recurrence after primary surgery. The fraction of proliferating cells was based on a count of at least 500 tumor cells in the area including the hot spot. The Ki-67 values were divided into 3 groups, namely <20, ≥20 and ≥50%. The investigated items included estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), tumor size, nodal status for the primary tumor, recurrence site (soft tissue, bone and viscera) and disease-free interval (DFI). The Cox's proportional hazard model was used to perform univariate and multivariate analyses of the factors associated with overall survival (OS) following recurrence. The median follow-up period was 65.9 months in the surviving group. The median Ki-67 value at baseline was 20% in all the cases and 27% in the recurrent cases. The Ki-67 values were low (24%) in patients with bone metastasis and significantly higher in patients with liver or brain metastasis (38 and 55%, respectively). Moreover, DFI was found to be inversely correlated with the Ki-67 values. Univariate analysis was performed to identify the prognostic factors for OS after recurrence. The significant factors included tumor size, lymph node status, ER, PgR, DFI, recurrence site and Ki-67 index value. Among these factors, a multivariate analysis identified the Ki-67 index value in the primary tumor as an independent significant factor, particularly in luminal type tumors. The Ki-67 index value in the primary tumor was a significant prognostic factor for OS after disease recurrence. It is, therefore, important to take the Ki-67 index value into consi deration for the treatment and follow-up of breast cancer patients.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Prognostic significance of Ki-67 index value at the primary breast tumor in recurrent breast cancer

Nishimura

Osako

Nishiyama

et al. 2014

Molecular and Clinical Oncology

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“…No one dropped out the NAC due to loss of follow-up or weak treatment compliance. There were dose reductions and/or delays for 52 women by neuropathic (37) and emetic (9) toxicity, surgery anticipation (4), or no clinical response (2). Dose reduction by only 20% (43) and/or one cycle (4) was the majority and therefore without influencing the overall efficacy of NAC.…”

Section: Variables and Treatmentmentioning

confidence: 99%

“…It presents heterogeneous molecular characteristics with great biological diversity and variable clinical outcomes [2].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Pathological Complete Response in Women with Clinical Complete Response to Neoadjuvant Chemotherapy in Breast Carcinoma

et al. 2018

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Objective: There is insufficient information on predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast carcinoma that also presented clinical complete response (cCR) evaluated in breast, axilla and breast and axilla. Methods: This retrospective study included 310 women with breast carcinoma who received NAC from 1/1/13 to 12/31/15 with follow-up until 8/31/16. The factors analyzed to predict pCR and cCR were menopausal status, Ki67, estrogen receptor, histologic grade, molecular subtype, tumor size, axilla status, and stage. Results: The cCR/pCR rates were 53.2/16.5% (breast), 76.3/36.8% (axilla) and 50.6/13.9% (breast and axilla). Molecular subtype and HER2-positive were independent predictors to confirm pCR in women with cCR, mainly triple negative (TN) in breast (OR 22.81, 95% CI 7.13–72.96) and breast and axilla (OR 36.06, 95% CI 8.77–148.26), but not in axilla. Ki67 ≥50% expression was predictor of cCR in breast (OR 2.00, 95% CI 1.31–3.06) and breast and axilla (OR 1.67, 95% CI 1.10–1.45). Conclusion: TN subtype and HER2-positive were the main independent predictors of pCR in women who also had cCR to NAC in breast and breast and axilla, but none was predictor in axilla. The Ki67 ≥50% was the independent predictor of cCR in breast and breast and axilla.

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“…Treatment decisions after initial diagnosis of HR breast cancer is determined by clinicopathological features and include presence of pathologically involved lymph nodes, large tumor size, high tumor grade, lymphovascular invasion, and/or high risk of recurrence based on a genomic assay (e.g., Recurrence Score [RS] >31 on the 21-gene recurrence assay) [22][23][24]. For patients who have completed treatment, studies have identified that a gene signature can be utilized to stratify risk of late distant metastases (>5-15 years).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Late (>5 Years) Distant Recurrences in Hormone Receptor (HR) Positive, Human Epidermal Growth Factor Receptor 2 (HER2) Negative Breast Cancer Patients: >20 Year Follow Up

Randhawa¹

2017

Austin J Clin Case Rep

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Background: Hormone Receptor (HR) positive Breast Cancer (BC) by virtue of tumor dormancy can present with delayed systemic recurrence after adjuvant therapy, frequently years after initial diagnosis. The malignant cells remain quiescent or proliferate very slowly until they progress to overt cancer. Methods:Over 2500 charts of HR+/HER2 negative BC patients were reviewed. Patients with follow up <5 years, recurrence within 5 years and all local recurrences < or >5 years were excluded. 35 late distant recurrences were identified. Data was analyzed with 50 patients from the same group without recurrences during the same period. Following factors were used for analysis: age at diagnosis, longest tumor diameter, smoking history, clinical stage at diagnosis, Lymph Node Involvement (LNI), tumor-grade, histology, Estrogen Receptor (ER) status, Progesterone Receptor (PR) status, duration of adjuvant therapy (≤5 years, >5 years ) and treatment modalities. Multivariate analysis was conducted using logistic regression and proportional hazards models. Results:The median/mean age at diagnosis was 58/58.5 years. Tumor size, T-stage at diagnosis, and duration of adjuvant therapy were associated with late relapse (p≤ 0.025, p≤ 0.012, p≤ 0.037 respectively). T-stage at diagnosis was the only independent predictor identified; with an estimated odds ratio of 2.62 (95% CI: 1.22, 5.64). Conclusion:In univariate analysis, the tumor diameter, T-stage at diagnosis and duration of adjuvant therapy are associated with both recurrence and time to relapse. Patients who received adjuvant endocrine therapy ≥5 years had decreased rate of late recurrences. In multivariate analysis, T-stage at diagnosis is the only independent predictor.

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Evaluation of Factors Related to Late Recurrence - Later than 10 Years after the Initial Treatment - in Primary Breast Cancer

Cited by 9,355 publications

References 72 publications

Prognostic significance of Ki-67 index value at the primary breast tumor in recurrent breast cancer

Prognostic significance of Ki-67 index value at the primary breast tumor in recurrent breast cancer

Predictors of Pathological Complete Response in Women with Clinical Complete Response to Neoadjuvant Chemotherapy in Breast Carcinoma

Predictive Factors for Late (>5 Years) Distant Recurrences in Hormone Receptor (HR) Positive, Human Epidermal Growth Factor Receptor 2 (HER2) Negative Breast Cancer Patients: >20 Year Follow Up

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