Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Early Recurrence of Breast Cancer after the Primary Treatment: Analysis of Clinicopathological and Radiological Predictive Factors

유방암 일차치료 후 조기 재발: 임상병리학적 및 영상의학적 예측인자 분석

  • Sun Geun Yun (Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yeong Yi An (Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung Hun Kim (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Bong Joo Kang (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 윤선근 (가톨릭대학교 의과대학 성빈센트병원 영상의학과) ;
  • 안영이 (가톨릭대학교 의과대학 성빈센트병원 영상의학과) ;
  • 김성헌 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 강봉주 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Received : 2019.05.24
  • Accepted : 2019.08.12
  • Published : 2020.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose To evaluate the value of clinicopathologic factors and imaging features of primary breast cancer in predicting early recurrence after the primary treatment. Materials and Methods We enrolled 480 patients who had been followed-up after breast-conserving surgery and adjuvant therapy from January 2010 to December 2014 at our hospital. Early recurrence was defined as recurrence within 3 years after completion of primary treatment, and univariate and multivariate logistic regression analyses were performed to determine the clinicopathologic and imaging predictive factors of early recurrence. Results In the univariate analysis, among the clinicopathologic factors, advanced stage (p = 0.021), high histologic grade (p < 0.001), estrogen receptor negative (p = 0.002), high Ki-67 proliferation index (p = 0.017), and triple-negative breast cancer (p = 0.019), and among the imaging features, multifocality (p < 0.001), vessels in the rim on Doppler ultrasonography (US) (p = 0.012), and rim enhancement (p < 0.001) on magnetic resonance imaging of the breast were significantly associated with early recurrence. In the multivariate analysis, advanced stage [odds ratio (OR) = 3.47; 95% confidence interval (CI) 1.12-10.73; p = 0.031] and vessels in the rim on Doppler US (OR = 3.32; 95% CI 1.38-8.02; p = 0.008) were the independent predictive factors of early recurrence. Conclusion Vascular findings in the rim of the primary breast cancer on Doppler US before treatment is a radiologic independent predictive factor of early recurrence after the primary treatment.

목적 유방암 일차치료 후 조기 재발 예측에 도움이 되는 임상병리학적 인자 및 원발암의 영상의학적 특징을 알아보고자 하였다. 대상과 방법 본원에서 2010년 1월부터 2014년 12월까지 유방 보존 수술 및 보조요법 치료 후 추적관찰을 받은 480명을 대상으로 하였다. 일차치료 완결 후 3년 이내 재발한 경우를 조기재발으로 정의하고, 이와 관련된 임상병리학적 및 영상의학적 예측인자를 알아보기 위해 단변량 및 다변량 로지스틱 회귀분석을 시행하였다. 결과 단변량 분석에서 임상병리학적 인자 중 높은 종양 병기(p = 0.021), 고등급 조직학적 분화도(p < 0.001), estrogen receptor 수용체 음성(p = 0.002), Ki-67 과발현(p = 0.017), 삼중음성유방 아형(p = 0.019)과, 영상 소견 중 유방암의 다초점성(p < 0.001), 도플러 검사에서 테두리 혈류(p = 0.012), 자기공명영상에서 테두리 조영증강(p < 0.001)이 조기 재발과 유의한 연관성을 보였다. 다변량 분석에서 원발암의 높은 종양 병기[odds ratio (이하 OR) = 3.47, 95% confidence interval (이하 CI) 1.12~10.73, p = 0.031]와 도플러 검사에서 테두리 혈류 (OR = 3.32, 95% CI 1.38~8.02,p = 0.008)가 조기 재발과 관련된 독립적인 예측인자였다. 결론 유방암 치료 전 도플러 검사에서 원발암의 테두리 혈류 소견은 유방암의 일차치료 후 조기 재발의 독립적인 영상의학적 예측인자이다.

Keywords

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424
  2. Jung KW, Won YJ, Kong HJ, Lee ES; Community of Population-Based Regional Cancer Registries. Cancer Statistics in Korea: incidence, mortality, survival, and prevalence in 2015. Cancer Res Treat 2018;50:303-316
  3. Park EH, Min SY, Kim Z, Yoon CS, Jung KW, Nam SJ, et al. Basic facts of breast cancer in Korea in 2014: the 10-year overall survival progress. J Breast Cancer 2017;20:1-11
  4. Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, et al. Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 2016;375:209-219
  5. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34
  6. Gonzalez-Angulo AM, Morales-Vasquez F, Hortobagyi GN. Overview of resistance to systemic therapy in patients with breast cancer. Adv Exp Med Biol 2007;608:1-22
  7. Soerjomataram I, Louwman MW, Ribot JG, Roukema JA, Coebergh JW. An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 2008;107:309-330
  8. Hatteville L, Mahe C, Hill C. Prediction of the long-term survival in breast cancer patients according to the present oncological status. Stat Med 2002;21:2345-2354
  9. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 2006;24:2028-2037
  10. Mansell J, Monypenny IJ, Skene AI, Abram P, Carpenter R, Gattuso JM, et al. Patterns and predictors of early recurrence in postmenopausal women with estrogen receptor-positive early breast cancer. Breast Cancer Res Treat 2009;117:91-98
  11. Payandeh M, Sadeghi M, Sadeghi E. Differences in prognostic factors between early and late recurrence breast cancers. Asian Pac J Cancer Prev 2015;16:6575-6579
  12. Neri A, Marrelli D, Rossi S, De Stefano A, Mariani F, De Marco G, et al. Breast cancer local recurrence: risk factors and prognostic relevance of early time to recurrence. World J Surg 2007;31:36-45
  13. Courdi A, Largillier R, Ferrero JM, Lallement M, Raoust I, Ettore F, et al. Early versus late local recurrences after conservative treatment of breast carcinoma: differences in primary tumor characteristics and patient outcome. Oncology 2006;71:361-368
  14. Nishimura R, Osako T, Nishiyama Y, Tashima R, Nakano M, Fujisue M, et al. Evaluation of factors related to late recurrence--later than 10 years after the initial treatment--in primary breast cancer. Oncology 2013;85:100-110
  15. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26 Suppl 5:v8-v30
  16. Kennecke H, McArthur H, Olivotto IA, Speers C, Bajdik C, Chia SK, et al. Risk of early recurrence among postmenopausal women with estrogen receptor-positive early breast cancer treated with adjuvant tamoxifen. Cancer 2008;112:1437-1444
  17. Lee KK, Kim JY, Jung JH, Park JY, Park HY. Clinicopathological feature and recurrence pattern of triple negative breast cancer. J Korean Surg Soc 2010;79:14-19
  18. Song WJ, Kim KI, Park SH, Kwon MS, Lee TH, Park HK, et al. The risk factors influencing between the early and late recurrence in systemic recurrent breast cancer. J Breast Cancer 2012;15:218-223
  19. Fitzpatrick DJ, Lai CS, Parkyn RF, Walters D, Humeniuk V, Walsh DC. Time to breast cancer relapse predicted by primary tumour characteristics, not lymph node involvement. World J Surg 2014;38:1668-1675
  20. Choi EJ, Choi H, Choi SA, Youk JH. Dynamic contrast-enhanced breast magnetic resonance imaging for the prediction of early and late recurrences in breast cancer. Medicine (Baltimore) 2016;95:e5330
  21. D'Orsi CJ. ACR BI-RADS atlas: breast imaging reporting and data system. Reston: American College of Radiology 2013
  22. Shaikh T, Tam TY, Li T, Hayes SB, Goldstein L, Bleicher R, et al. Multifocal and multicentric breast cancer is associated with increased local recurrence regardless of surgery type. Breast J 2015;21:121-126
  23. Lang Z, Wu Y, Li C, Li X, Wang X, Qu G. Multifocal and multicentric breast carcinoma: a significantly more aggressive tumor than unifocal breast cancer. Anticancer Res 2017;37:4593-4598
  24. Bae MS, Chang JM, Cho N, Han W, Ryu HS, Moon WK. Association of preoperative breast MRI features with locoregional recurrence after breast conservation therapy. Acta Radiol 2018;59:409-417
  25. Folkman J. What is the evidence that tumors are angiogenesis dependent? J Natl Cancer Inst 1990;82:4-6
  26. Folkman J. Role of angiogenesis in tumor growth and metastasis. Semin Oncol 2002;29:15-18
  27. Heimann R, Ferguson D, Gray S, Hellman S. Assessment of intratumoral vascularization (angiogenesis) in breast cancer prognosis. Breast Cancer Res Treat 1998;52:147-158
  28. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma. N Engl J Med 1991;324:1-8
  29. Bosari S, Lee AK, DeLellis RA, Wiley BD, Heatley GJ, Silverman ML. Microvessel quantitation and prognosis in invasive breast carcinoma. Hum Pathol 1992;23:755-761
  30. Leek RD, Landers RJ, Harris AL, Lewis CE. Necrosis correlates with high vascular density and focal macrophage infiltration in invasive carcinoma of the breast. Br J Cancer 1999;79:991-995
  31. Hasebe T, Tsuda H, Hirohashi S, Shimosato Y, Tsubono Y, Yamamoto H, et al. Fibrotic focus in infiltrating ductal carcinoma of the breast: a significant histopathological prognostic parameter for predicting the longterm survival of the patients. Breast Cancer Res Treat 1998;49:195-208
  32. Lee SH, Cho N, Kim SJ, Cha JH, Cho KS, Ko ES, et al. Correlation between high resolution dynamic MR features and prognostic factors in breast cancer. Korean J Radiol 2008;9:10-18
  33. Jinguji M, Kajiya Y, Kamimura K, Nakajo M, Sagara Y, Takahama T, et al. Rim enhancement of breast cancers on contrast-enhanced MR imaging: relationship with prognostic factors. Breast Cancer 2006;13:64-73