Predictors for Metachronous Metastases in Early Breast Cancer: A Single Institution Study

Background: Breast cancer (BC) is considered the most common women cancer worldwide. The main clinicopathological prognostic factors are tumor size, lymph node status and estrogen/progesterone (ER/PR) receptor status. In addition, some factors are both prognostic and predictive as ER/PR receptors and HER2/neu overexpression. Axillary lymph node status is the most important prognostic factor for breast cancer. Node negative breast cancer patients had the best 5-year overall survival (OS) of 82.8% compared to 73%, 45.7%, and 28.4% for patients with 1 - 3, 4 - 12, and ≥13 positive nodes, respectively. The aim of this study was to determine the association between different clinicopathological features and development of metastasis in a group of Egyptian women with early breast cancer, also, to assess patients’ Relapse-free survival (DFS) and OS and their correlation with different clinicopathological features. Patients and Methods: We retrospectively reviewed the files of breast cancer patients who were treated and followed-up at the clinical oncology department and surgical oncology unit, Alexandria Main University Hospital during the period from January 2014 to December 2017. A total of 1848 breast cancer cases were presented during this period of time. 141 out of the 1848 patients developed metastasis from breast cancer during follow-up. Among the 141 patients, only 102 had adequate clinical, pathological, treatment and follow-up data enough for analysis and were included in our study. Results: The number of patients who developed distant metastasis from breast cancer during the study period (metachronous metastasis) ranges from 17 - 31 cases/year. All the study patients had documented metastatic disease constituting 102 out of 1848 collected patients representing about 5.5%. The median time for development of metastasis from the initial diagnosis among the 102 studied patients was 17.88 months. Seventy-two out of 102 cases had distant recurrence. There was a significant correlation between DFS and tumor size, grade, number of lymph nodes involved and hormone receptor (ER and PR) status. Age, tumor grade, tumor size and Her2 status had a significant impact on the OS. Conclusion: The clinicopathological characteristics of the primary tumor are important for predicting the risk of metastasis among early breast cancer patients and determining their prognosis.