A total of 316 (17%) of the patients relapsed during a median follow-up period of 75 months. HER2 overexpression, triple negative subtype, high histological grade, and TNM stage 3 were identified as independent risk factors for breast cancer recurrence. The authors developed a scoring system based on these risk factors as follows: score 0 = no risk factor; score 1 = 1 risk factor; score 2 = 2 risk factors; and score 3 = 3 risk factors. Patients with a score of 0 to 2 were found to have relatively low risk of relapse, whereas those with a score of 3 were at high risk. The high-risk group was comprised of two subgroups: (1) HER2 positive breast cancer patients with a high histological grade and TNM stage 3; and (2) triple negative breast cancer with a high histological grade and TNM stage 3. The overall relapse rate of the low-risk group was 16%, with a 12% rate of distant metastasis. The relapse rate for the high-risk group was 53%, with a 51% rate of distant metastasis. The median relapse-free survival period for high-risk patients was 49 months (the study follow-up period was not long enough to determine this period for the low-risk group). The majority of recurrences occurred within three years of surgery for high-risk patients. The five-year survival rate among the high-risk patients was 65% compared to 96% for those with low risk. The authors conclude that there is a need to implement individualized surveillance protocols based on breast cancer subtypes and risk of relapse, with more focus on patients with a high risk of relapse.
Follow-up after breast cancer should take into account risk of relapse
Posted: July 7, 2010
A total of 316 (17%) of the patients relapsed during a median follow-up period of 75 months. HER2 overexpression, triple negative subtype, high histological grade, and TNM stage 3 were identified as independent risk factors for breast cancer recurrence. The authors developed a scoring system based on these risk factors as follows: score 0 = no risk factor; score 1 = 1 risk factor; score 2 = 2 risk factors; and score 3 = 3 risk factors. Patients with a score of 0 to 2 were found to have relatively low risk of relapse, whereas those with a score of 3 were at high risk. The high-risk group was comprised of two subgroups: (1) HER2 positive breast cancer patients with a high histological grade and TNM stage 3; and (2) triple negative breast cancer with a high histological grade and TNM stage 3. The overall relapse rate of the low-risk group was 16%, with a 12% rate of distant metastasis. The relapse rate for the high-risk group was 53%, with a 51% rate of distant metastasis. The median relapse-free survival period for high-risk patients was 49 months (the study follow-up period was not long enough to determine this period for the low-risk group). The majority of recurrences occurred within three years of surgery for high-risk patients. The five-year survival rate among the high-risk patients was 65% compared to 96% for those with low risk. The authors conclude that there is a need to implement individualized surveillance protocols based on breast cancer subtypes and risk of relapse, with more focus on patients with a high risk of relapse.