| Background:According to the latest data released by the International Agency for Research on Cancer(Globocan),there was 2.3 million new cases of breast cancer in women worldwide in 2020,which has surpassed lung cancer and became the most common malignant tumor in the world.About 680,000 people died because of breast cancer.Breast cancer has been the main cause of cancer death in women.China accounts for 12.2%of all newly diagnosed breast cancer cases and 9.6%of all breast cancer deaths globally.In recent years,the incidence of breast cancer among Chinese women has been increasing year by year.According to data from the National Cancer Center,304,000 new cases of breast cancer among Chinese women in 2015,accounting for 17.10 percent of the new cases of cancer in women that year,and 31,000 deaths from breast cancer.The increasing incidence of breast cancer poses a severe challenge to the prevention and treatment of breast cancer for our country.Although the prognosis of hormone receptor positive breast cancer is better than that of other molecular subtypes,this subtype accounts for 60-80%of all breast cancer patients and needs to be focused on this part of the patients.In recent years,with the progress of diagnosis and treatment technology,the survival time of breast cancer patients has been steadily improved,but there are still about 30%of patients with early breast cancer will have recurrence and metastasis in the subsequent treatment process,recurrence and metastasis events are the main cause of death of breast cancer patients.The time of recurrence and metastasis of breast cancer was bimodal,and the first peak of recurrence and metastasis usually occurred in the second year after surgery.Early metastasis of breast cancer was defined as the time from the pathological diagnosis of breast cancer to the occurrence of distant metastasis less than 2 years.In addition,primary endocrine resistance was defined as recurrence and metastasis within 2 years of postoperative adjuvant endocrine therapy.Therefore,2 years after surgery is a significant point for recurrence and metastasis in patients with hormone receptor positive breast cancer.At present,clinical decisions on the diagnosis and treatment of patients with recurrence and metastasis are mostly based on clinicopathological data,and the influence of time of recurrence and metastasis on treatment decisions is rarely considered.Previous studies also focused on the incidence and risk of recurrence and metastasis of breast cancer,and few studies compared the differences in clinicopathological factors and prognosis of patients with different recurrence and metastasis times.Through literature review,we found that only a small number of studies took 5 years as a point to analyze the differences in clinicopathological factors in patients with different recurrence and metastasis times of hormone receptor positive recurrence and metastasis.But no studies comparing the clinicopathological factors in patients with early and late recurrence hormone receptor positive breast cancer at the 2-year point.Therefore,this study included in hormone receptor positive breast cancer patients of postoperative recurrence of a transfer,with 2 years as a distinction between early and late recurrence,comparing the clinicopathological factors difference between early and late recurrent hormone receptor positive breast cancer patients.To provide thinking for the diagnosis and treatment of hormone receptor positive recurrent metastatic breast cancer.Objectives:1.To investigate the time and site of the first recurrence and metastasis in patients with hormone receptor positive relapsed and metastatic breast cancer.2.Comparing clinicopathological factors’ difference between early and late recurrent hormone receptor positive breast cancer patients.Methods:The medical records of breast cancer patients with recurrence and metastasis after hormone receptor positive surgery treated in the Second Hospital of Shandong University from 2011 to 2018 were collected.Survival information,time and location of the first recurrence and metastasis were obtained through follow-up.The time and location of the first recurrence and metastasis were analyzed by histogram,pie chart and composition ratio.The difference in clinicopathological factors between patients with early and late recurrence was compared.The t-test was used for continuous variables,the chi-square test or Fisher test was used for classified variables,and the Wilcoxon rank sum test was used for T stage,N stage,and TNM stage(grade variables).The variables with statistical significance for the analysis results were included in the Logistic multivariate analysis.SPSS version 26.0 was used for statistical analysis of all data,and p<0.05 was considered statistically significant.Results:1.General clinical characteristics of hormone receptor positive patients with recurrent metastasis of breast cancerAccording to the inclusion and exclusion criteria,a total of 105 patients who met the requirements were included.The follow-up ended in January 2021,with a median follow-up time of 65.8 months.The number of cases with the first recurrence and metastasis time of 1-5 years and more than 5 years were:20 cases(19.0%),32 cases(30.5%),19 cases(18.1%),13 cases(12.4%),10 cases(9.5%),11 cases(10.5%).According to 2 years as the point,they were divided into two groups,including52 patients in early recurrence group,accounting for 49.5%;53 patients(50.5%)were in the late recurrence group.There were 10(9.5%)patients with the first recurrence and metastasis to multiple organs,and 95(90.5%)patients with single organ metastasis.Among the patients with single organ recurrence and metastasis for the first time,29 cases(30.5%)had chest wall breast recurrence,13 cases(13.7%)had lymph node metastasis,22 cases(23.2%)had bone metastasis,17 cases(17.9%)had lung metastasis,10 cases(10.5%)had liver metastasis,and 4 cases(4.2%)had brain metastasis.2.Comparison of clinicopathological data between patients with early and late recurrence of hormone receptor positive breast cancer.Compared with the late recurrence group,the early recurrence group had larger tumors(3.49±1.53cm vs.2.45±1.14cm,p<0.001)and lower ER expression(55.23±38.53%vs.75.75±24.88%,p=0.002),higher Ki67 index(42.29±21.98%vs.32.64±20.28%,p=0.021),higher clinical T stage,N stage,TNM stage(p<0.001),and Luminal B type patients more(90.4%vs.73.6%,p=0.025).Results that were statistically different in univariate analysis and did not duplicate:tumor size,ER expression percentage,and Ki67 index were included in multivariate analysis.ER expression percentage(OR=0.983,95%CI:0.970-0.996,p=0.012),tumor size(OR=1.733,95%CI:1.227-2.448,p=0.002)there was a statistically significant difference between the early recurrence group and the late recurrence group.Conclusion:1.Bone metastasis is the most common site of first distant metastases from a single organ in patients with hormone receptor positive breast cancer.2.Larger tumor size and lower ER expression percentage are independent risk factors for early recurrence in patients with hormone receptor positive breast cancer. |
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