Relapse profile and recurrence free survival of breast cancer patients – bridging the gap in Sri Lanka

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.