Prognostic Factors of Recurrence (Early and Late) and Death in Breast Cancer Patients in Iranian Women

Abstract

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.