Prognostic factors of early distant recurrence in hormone receptor-positive, postmenopausal breast cancer patients receiving adjuvant tamoxifen therapy : Results of a retrospective analysis
✍ Scribed by Marc Debled; Gaëtan MacGrogan; Véronique Brouste; Simone Mathoulin-Pelissier; Michel Durand; Louis Mauriac
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 99 KB
- Volume
- 109
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Abstract
BACKGROUND
Current adjuvant hormone therapy in postmenopausal women with breast cancer is debatable between upfront aromatase inhibitors (AIs) and sequential treatment with tamoxifen. A major concern is the higher rate of early recurrences observed with sequential treatment. The authors conducted a retrospective analysis to identify risk factors of early recurrences in hormone receptor (HR)‐positive, postmenopausal women within the first 3 years of adjuvant tamoxifen.
METHODS
Between 1986 and 2000, operable breast cancer patients who received exclusively adjuvant tamoxifen for at least 3 years were selected from the authors' institutional database. Age, histology, pathologic tumor size, modified Scarff‐Bloom‐Richardson (mSBR) grade, mitotic index, tumor necrosis, peritumoral vascular emboli (PVE), HR status, and the number of involved axillary lymph‐node were considered as prognostic factors of recurrence.
RESULTS
Among 715 patients who met the inclusion criteria, a distant recurrence occurred in 38 patients (5.3%) within the first 3 years of tamoxifen therapy. Significant prognostic factors of early recurrence were mSBR, axillary lymph node involvement, tumor necrosis, mitotic index, PVE, and pathologic tumor size. Grade 1 and/or lymph node‐negative tumors were excluded from the multivariate analysis (1 recurrence in 208 patients). In this model, mSBR grade 3 was the only significant predictive factor of early recurrence (hazard ratio, 3.72; P < .001).
CONCLUSIONS
In this study, a subset of patients was identified that was at low‐risk of early recurrence (mSBR grade 1 and/or negative lymph node status). Women in that subset could be treated using sequential hormone therapy with tamoxifen and AIs. In women with mSBR grade 3 or lymph node‐positive tumors, an upfront treatment with AIs seemed to be the current optimal strategy. Cancer 2007. © 2007 American Cancer Society.