Distinct Characteristics and Metastatic Behaviors of Late Recurrence in Patients With Hormone Receptor-positive/Human Epidermal Growth Factor Receptor 2-negative Breast Cancer: A Single Institute Experience of More Than 10 Years

Late recurrence is very common for hormone receptor-positive breast cancer, but little is known about it. We compared the characteristics of early and late recurrence in 390 patients. They differed from each other in many ways, and late recurrence had a much better prognosis. More attention should be put on late recurrence itself. Introduction: Patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR ⁺ /HER2 ⁻ ) breast cancer have a constant risk of relapse over time. Nearly one-half of the recurrences occur more than 5 years after diagnosis, described as late recurrence, but little is known about late recurrence. Patients and Methods: We reviewed the clinical data of 1941 patients with HR ⁺ /HER2 ⁻ breast cancer who had operations in the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, during 2003 to 2009, and found 390 relapsed cases. Among them, 281 patients were early recurrence, and 109 were late recurrence. Results: In the late recurrence group, patients with ≤ 3 lymph node metastases, double HR ⁺ (estrogen receptor-positive/progesterone receptor-positive) were more common (72.48% vs. 55.52%; P =.005; 82.57% vs. 71.89%; P =.029, respectively) when compared with the early recurrence group. The lung seemed to be a preferential site of late recurrence. Although visceral disease and multi-organ metastases were more frequent in the late recurrence group, survival after recurrence was significantly longer than that in the early recurrence group (52 vs. 40 months; hazard ratio, 1.508; 95% confidence interval, 1.142-1.992; P =.003). Moreover, progression-free survival of first-line treatment was an independent prognostic factor of survival after recurrence in the late recurrence group. Conclusion: Late recurrence differed from early recurrence in many ways in HR ⁺ /HER2 ⁻ breast cancer, and its prognosis was much better. The lung may be a preferential site of late recurrence. More attention should be paid to late recurrence itself.