Research Of The Factors Influencing The Recurrence And Metastasis Of Operable Breast Cancer After Mastectomy

Breast cancer is the most common malignant tumor in women. Owing to the development of early diagnosis, early treatment and adjuvant therapy, the disease free survival and overall survival after surgery of this disease have been rising obviously. However, recurrence and metastasis after operation are important causes inducing patients'death who suffer from operable breast cancer. The known factors that can influence the recurrence and metastasis of operable breast cancer can be divided into two groups. One group of the factors are the clinical and pathological factors, which include age, pathological type, histological and nuclear degree, size of tumor, lymph node status, hormone receptor status, operation mode, adjuvant chemotherapy, endocrinotherapy, radiotherapy and newcome biotherapy, neo-adjuvant chemotherapy and endocrinotherapy. Previous researches indicated that patients of young or premenopausal age, nonspecial type invasive carcinoma, highly malignant histological degree, advanced tumor stage, negative hormone receptor status and without standard adjuvant therapy would increase the recurrent and metastastic risk of breast cancer after surgery. Another group of factors are the tumor molecular biological factors. Researches have suggested that there are several kinds of factors involved in the incidence, development, recurrence and metastasis. Acknowledged factors are ER, PR, HER-2, p53, and so on. Recent researches indicated that overexpression of SRC-1 may be involved in the breast cancer recurrence and metastasis. Our research has analyzed the differences of clinical and pathological factors and some molecular biological factors between the patients who had recurred and/or metastasized in 5 years after mastectomy and those who had survived with disease free for at least 5 years after surgery, in order to find out the influential factors in the recurrence and metastasis of operable breast cancer and the clinical methods which might improve the prognosis of breast cancer. Methods & ResultsPart I. Analysis of Clinical and Pathological Factors Influencing Recurrence and Metastasis of Operable Breast Cancer after MastectomyMethods: The data of the female operable breast cancer patients, who were treated with mastectomy in the Southwest Hospital between May, 1997 and August, 2005, was collected. 81 patients had recurred and/or metastasized in 5 years after operation, were in recurrence and metastasis group. Other 81 patients in the same period, who have survived with disease free for at least 5 years, were in another group. We analyzed the differences of clinical and pathological factors, including age, tumor pathological type, size of tumor, lymph node status, hormone receptor status, endocrinotherapy and adjuvant chemotherapy, between the two groups, and analyzed the synergistic effect of these factors.Results: 88.89% patients had recurred and/or metastasized in 3 years after mastectomy. Local recurrence and liver, lung and bone metastasis are the main manners. The results of single factor analysis indicate that the patient who is under 40 years old, with nonspecial type invasive carcinoma, advanced tumor stage, negative ER and PR status, or without standard adjuvant therapy, will suffer recurrence and metastasis much more frequently (p﹤0.05). The results of multiplicity indicate that patients without adjuvant chemotherapy will represent no difference between recurring and metastasizing or not, even there are differences in the size of tumor and hormone receptor status. However, patients with standard chemotherapy and small size of tumor or positive hormone receptor status will suffer recurrence and metastasis less possibly. Patients with advanced tumor stage, negative ER and PR status will recur and metastasize more frequently, no matter that they are elder or younger than 40 years old. Synergistic effect exists between each two factors referred.Part II. Exploring of the Molecular Factors Related with Recurrence and Metastasis of Operable Breast Cancer after MastectomyMethods: We matched 40 pairs from the two groups, according with the similar condition of adjacent age, consistent menstruation status, pathological type, tumor stage, and adjuvant chemotherapy situation, to detect the expression of ER, PR, HER-2, p53 and SRC-1 by immunohistochemistry. McNemar test was used to analyze the relationship between the expression of factors and recurrence and metastasis of breast cancer after mastectomy. Results: The expression of HER-2 and SRC-1 is higher, and that of ER is lower in recurred and/or metastasized patients group, compared with those in patients with disease free group. There are statistical differences between the two groups. However, the expression of p53 and PR represents no difference. The results from correlation analyze indicate that there is relationship between the expression of ER & PR, HER-2 & p53, and HER-2 & SRC-1.Conclusions1. The peak period of recurrence and metastasis of breast cancer appears in 3 years after mastectomy. It suggests should pay more attention to the follow-up survey and prevention. Local status, liver, lung and bone are the key points.2. Standard adjuvant chemotherapy is one of the most important factors influencing the prognosis of breast cancer, and may depress the risk of recurrence and metastasis more efficiently than other factors. Chemotherapy and endocrinotherapy in turn may be accepted by all the patients with positive hormone receptor, no matter with their age. Both early diagnosis and standard treatment remain keys of depressing the breast cancer recurrence and metastasis and raising the survival rate.3. ER, HER-2 and SRC-1 are important for the breast cancer prognosis. HER-2 may be the key point of the breast cancer recurrence and metastasis.