Late Recurrences in Luminal-Like Breast Cancer

Purpose: The intention of this study is to both examine the disease entity and late recurrences of luminal-like (hormonal receptor positive and HER2-negative) breast cancer, and identify the prognostic factors associated with disease recurrences. Materials and Methods: We selected for this study breast cancer patients initially treated with primary surgeries in our institution between 1990 and 2007, who also fit the following criteria: 1) pathology stage I-III, 2) hormonal receptor-positive, and 3) HER2/neu-negative. Out of the total 1763 eligible patients, 1275 (72%) received adjuvant chemotherapy, 937 (53%) underwent radiotherapy, and 1629 (92%) had hormonal therapy. Cox proportional hazards regression models were used to assess the prognostic significance of the risk factors related to disease recurrences. Results: The five- and ten-year disease-free survival rates were 96% and 91% for stage I patients, 90% and 81% for stage II, and 79% and 65% for stage III patients, respectively. The incidence of recurrence at each stage in the first 5 years was almost equal to that in the second 5 years. The independent risk factors, according to the multivariate analysis, were: age ≤ 40 (hazard ratio [HR] 1.8, 95% confidence interval [CI], 1.4-2.5); tumor ＞ 2cm (HR 1.6, 95% CI, 1.1-2.1); axillary lymph node positive (HR 1.9/2.0/3.9, 95% CI, 1.3-2.8/1.2-3.4/2.2-6.8 for node positive 1-3/4-9/≥10, respectively); nuclear grade III (HR 1.4, 95% CI, 1.1-1.9); the presence of ECS (HR 1.6, 95% CI, 1.1-2.30); and adjuvant hormonal therapy (HR 0.48, 95% CI, 0.30-0.76). Conclusions: Luminal-like (hormonal receptor positive and HER2-negative) breast cancer has excellent long-term outcomes, but also has a considerable frequency of late recurrences. The risk of breast cancer recurrence is relatively high for patients ≤ 40 years of age, with tumor size greater than 2cm, with axillary LN metastasis, status of nuclear grade III, or with ECS involvement. Clinical trials should be considered for these high-risk breast cancer patients, especially for patients who are diagnosed at 40 years of age or younger.