随着时间的推移，激素受体阳性HER2阴性乳腺癌患者始终存在复发风险。将近一半的复发发生于诊断后5年以上，被称之为晚期复发。但是，对于晚期复发，目前所知不多。
2018年12月1日，爱思唯尔旗下《临床乳腺癌》正式发表中国医学科学院北京协和医院肿瘤医院国家癌症中心国家肿瘤临床医学研究中心陈雪莲、樊英、徐兵河等学者的研究报告，根据单中心10年以上经验，分析了激素受体阳性HER2阴性乳腺癌患者晚期复发的不同特征和转移方式。
该研究对2003～2009年中国医学科学院肿瘤医院1941例激素受体阳性HER2阴性乳腺癌手术患者的临床资料进行回顾。
结果，复发共计390例。其中，早期复发281例，晚期复发109例。
晚期复发组与早期复发组相比：
淋巴结转移≤3枚比例显著较高（72.48%比55.52%，P=0.005）
双激素受体阳性比例显著较高（82.57%比71.89%，P=0.029）
首先转移至肺部比例显著较高（47.7%比25.26%，P<0.001）
内脏转移比例显著较高（55.96%比43.77%，P=0.03）
多器官转移比例显著较高（51.38%比32.74%，P=0.001）
复发后生存时间反而较长（52比40个月，风险比：1.508，95%置信区间：1.142～1.992，P=0.003）
一线治疗客观缓解率相似（57.00%比52.41%，P=0.126）
一线治疗无进展生存反而较长（22比15个月，P=0.023）
此外，根据皮尔逊相关性分析，晚期复发组的一线治疗无进展生存与复发后生存成正比（r=0.523，P<0.001）。晚期复发组的一线治疗无进展生存>12与≤12个月相比，复发后生存时间显著较长（35比90个月，风险比：2.692，95%置信区间：1.590～4.560，P<0.001）。晚期复发组的一线治疗缓解与未缓解患者相比：
无进展生存时间显著较长（27比13个月，P=0.013）
复发后生存时间显著较长（66比45个月，P<0.001）
因此，根据该单中心超过10年回顾研究结果，激素受体阳性HER2阴性乳腺癌的晚期复发与早期复发相比，淋巴结转移≤3枚、双激素受体阳性、首先转移至肺部、内脏转移、多器官转移的比例显著较高，复发后生存时间、一线治疗无进展生存时间反而较长，故应予以晚期复发更多关注。
Clin Breast Cancer. 2018 Dec 1;18(6):e1353-e1360.
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.
Chen X, Fan Y, Xu B.
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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.
Clinical Practice Points
Late recurrence is a common metastatic pattern for hormone receptor-positive breast cancer.
There is an unmet need for predictors of late recurrence, and little attention has been put on the metastatic behaviors of late recurrence, as wee.
We investigated the distinct characteristics of late recurrence in both the early and metastatic settings, and found that ≤ 3 lymph node metastases and double HR+ status were more common in late recurrence, and the lung was a preferential site of late recurrence. In addition, late recurrence had a much better prognosis than early recurrence, especially for those who achieved a longer progression survival after first-line treatment.
A whole course management of late recurrence was emphasized in our study.
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.
KEYWORDS: Breast neoplasm; Hormone receptor-positive; Human epidermal growth factor receptor 2 negative; Late recurrence; Prognosis
PMID: 30201586
PII: S1526-8209(18)30303-3
DOI: 10.1016/j.clbc.2018.07.014
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