Abstract:
bstract: Breast cancer (BC) is the commonest cancer among females in Sri Lanka since 2000. This
study was designed to determine the profile of recurrences, recurrence free survival (RFS) and the
impact of the clinico-pathological features on the RFS of BC patients in the Southern Sri Lanka. This
retro-prospective study included BC patients who sought the services from the
Immunohistochemistry laboratory at the Department of Pathology, Faculty of Medicine, University
of Ruhuna from May 2006 to December 2012. Tumour grading and scoring for estrogen receptor
(ER), progesterone receptor (PR) and Her2 were done by principle investigator. The Chi-square test,
Kaplan-Meier model and the Cox-regression model were used for data analysis using SPSS. A total
of 923 BC patients were included. Of 923 out of the total, 188 had at least one recurrence (local-34,
distant-154) during a mean follow up period of 45 months. Five year RFS was 74% (local- 94%,
distance-78%). The RFS decreased with the increasing tumour size (p=0.002), Nottingham grade
(p=0.002), lymph-node stage (p<0.001), pathological stage (p<0.001), NPI (p=<0.001) and with the
presence of lympho-vascular invasion (p=0.011). ER positive (p=0.032), PR positive (p=0.008) and
Her2 negative (p=0.025) tumours had an increased RFS. In the multivariate analysis, lymph node
stage1-3 (p<0.001), Nottingham grade 3 (p=0.006) and expression of PR (p=0.024) became
significant. Lymph node stage, Nottingham Grade and expression of PR have an independent effect
on the RFS of BC patients in Southern Sri Lanka. Lymph node stage is the best predictor of recurrent
breast cancer.
