Risk Factors and Survival Outcomes Associated with Breast Cancer Recurrence: Survival Outcomes Associated with Breast Cancer Recurrence

Syed Saad Gardezi; Muhammad Sami Ullah; Mehroosh Shakeel; Sadaf Shafique; Badar Masood; Bushra Nisar

doi:10.54393/pjhs.v6i10.3406

Authors

Syed Saad Gardezi Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
Muhammad Sami Ullah Department of Pathology, Nishtar Medical University, Multan, Pakistan
Mehroosh Shakeel Department of Histopathology, Shalamar Medical and Dental College, Lahore, Pakistan
Sadaf Shafique Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
Badar Masood Department of Clinical Oncology, Bahawalpur Institute of Nuclear Medicine and Oncology Cancer Hospital, Bahawalpur, Pakistan
Bushra Nisar Department of Pathology, Ameer ud Din Medical College, Postgraduate Medical Institute, Lahore General Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i10.3406

Keywords:

Breast Cancer, Recurrence, Risk Factors, Survival Outcomes, Molecular Subtype, Ki-67, Adjuvant Therapy, Prognostic Markers

Abstract

Breast cancer recurrence remains a major clinical challenge, despite advancements in diagnosis and treatment. Identifying reliable clinicopathological predictors is essential for improving long-term outcomes and guiding individualized treatment. Objective: To assess the clinicopathological characteristics and risk factors associated with breast cancer recurrence and evaluate survival outcomes in patients with operable breast cancer. Methods: This retrospective study included 281 patients diagnosed with operable primary breast cancer at a tertiary care center. Data were collected on demographic, histopathological, and treatment-related variables. Recurrence was defined as any documented local, regional, or distant relapse after initial treatment. Statistical analyses included chi-square tests for categorical variables and independent-samples t-tests for continuous variables to assess associations with recurrence. A p-value<0.05 was considered statistically significant. Results: The overall recurrence rate was 31.7 %, with distant metastasis being the most common type. Odds ratios with 95 % confidence intervals for categorical variables (molecular subtype, hormone receptor status, tumor size category, histological grade, Ki-67 index, and lymphovascular invasion) showed no statistically significant associations with recurrence. Likewise, mean differences with 95 % confidence intervals for continuous variables (age, tumor size, Ki-67 index, and disease-free survival) revealed no significant differences between recurrence and non-recurrence groups. Conclusions: No clinicopathological factor was found to be a statistically significant predictor of breast cancer recurrence in this cohort. These findings highlight the limitations of traditional pathological markers and underscore the need to integrate molecular and genomic profiling for more accurate recurrence risk assessment and personalized treatment planning.

References

Miyazaki N, Iwasaki T, Sakai H, Watanuki R, Tanizawa Y, Cai Z et al. Risk Factors for Recurrence in Patients with Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Early Breast Cancer in Japan: A Systematic Literature Review and Meta-Analysis. Current Medical Research and Opinion. 2024 May; 40(5): 827-37. doi: 10.1080/03007995.2024.2332436. DOI: https://doi.org/10.1080/03007995.2024.2332436

Shahmoradi M, Fazilat A, Ghaderi-Zefrehei M, Ardalan A, Bigdeli A, Nafissi N et al. Unveiling Recurrence Patterns: Analyzing Predictive Risk Factors for Breast Cancer Recurrence after Surgery. Cancer Informatics. 2024 Nov; 23: 11769351241297633. doi: 10.1177/11769351241297633. DOI: https://doi.org/10.1177/11769351241297633

Abdulwassi HK, Amer IT, Alhibshi AH, Alnajjar AA, Bahatheq AK, Trabulsi NH et al. Recurrence Rates and Long-Term Survival Factors in Young Women with Breast Cancer. Saudi Medical Journal. 2020 Apr; 41(4): 393. doi: 10.15537/smj.2020.4.24987. DOI: https://doi.org/10.15537/smj.2020.4.24987

Chen L, Chen Q, Zhu M. A Retrospective Analysis of Clinicopathological Characteristics and Risk Factors for Recurrence in Young Patients with Breast Cancer. Gland Surgery. 2024 Jul; 13(7): 1281. doi: 10.21037/gs-24-193. DOI: https://doi.org/10.21037/gs-24-193

Courtney D, Davey MG, Moloney BM, Barry MK, Sweeney K, McLaughlin RP et al. Breast Cancer Recurrence: Factors Impacting Occurrence and Survival. Irish Journal of Medical Science (1971-). 2022 Dec; 191(6): 2501-10. doi: 10.1007/s11845-022-02926-x. DOI: https://doi.org/10.1007/s11845-022-02926-x

Dogan I, Aydin E, Khanmammadov N, Paksoy N, Ferhatoğlu F, Ak N et al. Long-Term Outcomes and Predictors of Recurrence in Node-Negative Early Stage Breast Cancer Patients. Journal of Cancer Research and Clinical Oncology. 2023 Nov; 149(16): 14833-41. doi: 10.1007/s00432-023-05276-y. DOI: https://doi.org/10.1007/s00432-023-05276-y

Trabulus FD, Nazli MA, Arslan E, Mermut O, Dal F, Akce B et al. Predictors of Recurrence in Breast Cancer Patients with Pathological Partial Response. Revista da Associação Médica Brasileira. 2024 Apr; 70: e20231215. doi: 10.1590/1806-9282.20231215. DOI: https://doi.org/10.1590/1806-9282.20231215

Oyama Y, Kittaka N, Higuchi A, Togashi Y, Taniguchi A, Seto Y et al. Long-Term Survival Outcomes and Risk Factors for Axillary and Locoregional Recurrence in Japanese Patients with Sentinel Node-Positive Breast Cancer Treated in Accordance with the ACOSOG Z0011 Strategy. Oncology. 2025 Feb; 103(2): 143-55. doi: 10.1159/000540363. DOI: https://doi.org/10.1159/000540363

Lee JB, Choi J, An MS, Kim JY, Kwon SU, Kim J et al. Analysis of Prognostic Factors Influencing Survival and Recurrence in Breast Cancer: A Hybrid Machine Learning Approach. 2021. doi: 10.21203/rs.3.rs-946765/v1. DOI: https://doi.org/10.21203/rs.3.rs-946765/v1

Fadheel MA, Al-Humairi AK, Mohammed MQ. Identifying the Risk Factors of Local Recurrence of Early-Stage Breast Cancer After Surgery and Adjuvant Treatment. Medical Journal of Babylon. 2020 Apr; 17(2): 148-53. doi: 10.4103/MJBL.MJBL_12_20. DOI: https://doi.org/10.4103/MJBL.MJBL_12_20

Yekedüz E, Dizdar Ö, Kertmen N, Aksoy S. Comparison of Clinical and Pathological Factors Affecting Early and Late Recurrences in Patients with Operable Breast Cancer. Journal of Clinical Medicine. 2022 Apr; 11(9): 2332. doi: 10.3390/jcm11092332. DOI: https://doi.org/10.3390/jcm11092332

Uras C, Cabioglu N, Tokat F, Er O, Kara H, Korkmaz T et al. Favorable Locoregional Control in Clinically Node-Negative Hormone-Receptor Positive Breast Cancer with Low 21-Gene Recurrence Scores: A Single-Institution Study with 10-Year Follow-up. Cancer Research. 2023; 83 (5_Supplement): 11-31. doi: 10.1158/1538-7445.SABCS22-P2-11-31. DOI: https://doi.org/10.1158/1538-7445.SABCS22-P2-11-31

Campoverde L, Camacho F, Sanchez A, Lugo P. The Correlation Between Ki 67 and Oncotype Dx on HR+, HER2-Early Breast Cancer Management: Insights of Molecular Testing. Journal of Clinical Oncology. 2024; 42(16_suppl): e12546. doi: 10.1200/JCO.2024.42.16_suppl.e12546. DOI: https://doi.org/10.1200/JCO.2024.42.16_suppl.e12546

Amador-García G, Rodriguez-Meléndez EA, Martínez-Herrera JF, Andrade-Moreno RA, Reyes-Sánchez E, Vázquez-Juárez D et al. Abstract P3-07-12: Correlation Between Clinicopathological Characteristics and Oncotype Dx Recurrence Score (RS) in Early Breast Cancer. Experience in a Mexican population. Cancer Research. 2020 Feb; 80(4_Supplement): P3-07. doi: 10.1158/1538-7445.SABCS19-P3-07-12. DOI: https://doi.org/10.1158/1538-7445.SABCS19-P3-07-12

Zambelli A, Gallerani E, Garrone O, Pedersini R, Caremoli ER, Sagrada P et al. Working tables on Hormone Receptor Positive (HR+), Human Epidermal Growth Factor Receptor 2 Negative (HER2-) Early Stage Breast Cancer: Defining High Risk of Recurrence. Critical Reviews in Oncology/Hematology. 2023 Nov; 191: 104104. doi: 10.1016/j.critrevonc.2023.104104. DOI: https://doi.org/10.1016/j.critrevonc.2023.104104

Jia-Chun M, Xiao-Rong Z, Ting L, Zhong-Zheng X, Jia-Yuan L, Chuanxu L et al. The effect of Post-Mastectomy Radiotherapy on Breast Cancer Patients After Neoadjuvant Chemotherapy by Molecular Subtype. Annals of Surgical Oncology. 2021 Sep; 28(9): 5084-95. doi: 10.1245/s10434-020-09523-1. DOI: https://doi.org/10.1245/s10434-020-09523-1

Hou N, Wu J, Xiao J, Wang Z, Song Z, Ke Z et al. Development, Verification, and Comparison of A Risk Stratification Model Integrating Residual Cancer Burden to Predict Individual Prognosis in Early-Stage Breast Cancer Treated with Neoadjuvant Therapy. European Society for Medical Oncology Open. 2021 Oct; 6(5): 100269. doi: 10.1016/j.esmoop.2021.100269. DOI: https://doi.org/10.1016/j.esmoop.2021.100269

Fan Y, Ji D, Jiang M, Tan Y, Yang Y, Li T et al. Adjuvant Treatment Strategy Evolution and Risk Stratification for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 Negative Early Breast Cancer in China. The Oncologist. 2024 Sep; 29(9): e1104-12. doi: 10.1093/oncolo/oyae095. DOI: https://doi.org/10.1093/oncolo/oyae095

Moisini I, Zhang H, D’Aguiar M, Hicks DG, Turner BM. L1CAM Expression in Recurrent Estrogen Positive/HER2 Negative Breast Cancer: A Novel Biomarker Worth Considering. Applied Immunohistochemistry and Molecular Morphology. 2021 Apr; 29(4): 287-92. doi: 10.1097/PAI.0000000000000909. DOI: https://doi.org/10.1097/PAI.0000000000000909

Raju A, Raman J, Ravi K. Histopathological Variants and Molecular Subtypes of Carcinoma Breast in a Tertiary Care Centre, Kerala, India: A Cross-sectional Study. National Journal of Laboratory Medicine. 2023; 12(3): PO47-51. doi: 10.7860/NJLM/2023/63045.2752. DOI: https://doi.org/10.7860/NJLM/2023/63045.2752

Ponomarev VE, Polikarpova SB, Mekhtieva NI, Shagina NYu, Vishnevskaya YaV, Selivanova VV. Primary Resectable Breast Cancer: Molecular Biological Subtypes and Morphological Prognostic Factors. Sechenov Bulletin. 2019; 10(2): 5-13. doi: 10.47093/22187332.2019.2.5-13. DOI: https://doi.org/10.47093/22187332.2019.2.5-13

Munkácsy G, Santarpia L, Győrffy B. Gene Expression Profiling in Early Breast Cancer—Patient Stratification Based on Molecular and Tumor Microenvironment Features. Biomedicines. 2022 Jan; 10(2): 248. doi: /10.3390/biomedicines10020248. DOI: https://doi.org/10.3390/biomedicines10020248