The objective of this retrospective study was to characterize the sites of first relapse in a cohort of Tunisian patients with metastatic breast cancer relapsing after adjuvant therapy and to report survival results.
Among 1400 early breast cancer patients treated from 2000 to 2010, 324 (23%) relapses were divided into 4 groups according to first site of appearance: A-locoregional alone (breast and lymph nodes), B-Bone alone, C-Brain alone and D-other sites. Controlateral breast cancer was excluded. Clinico-pathological aspects and initial therapy were studied for each group. Survival results were reported.
In group A, 12 patients had local recurrence (8 after breast-conserving surgery), 37 patients had nodal recurrence (23 axillary, 14 sub-clavicular and 11 had both). Nine patients had surgical resection, 19 had radiation therapy and all patients received chemotherapy. In group B, 35 patients had palliative radiation, 50 had chemotherapy, bisphosphonates were available for 67 patients. In group C, we observed 4 cases of meningeal carcinomatosis, one case was operated, and all other cases had whole brain radiation. In group D, metastases were: liver (43), lung (32), pleural (27), peritoneal (12), gastric (3) and other (32). Seven patients had initial endocrine therapy, 3 patients had metastasectomy (2 liver, 1 lung) and the remaining had chemotherapy.
Patient characteristics according to site of recurrence groups
|A n = 60 (18%)||B n = 92 (29%)||C n = 23 (7%)||D n = 149 (46%)|
|Body mass index ≥ 35||24 (40%)||17 (18%)||7 (30%)||44 (29%)|
|Premenopaused||34 (56%)||54 (58%)||15 (65%)||89 (60%)|
In Tunisia, patterns of relapse according to first site of appearance are similar to results reported in the literature, being characterized by young age, large tumor size and aggressive histological features.
Clinical trial identification
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All authors have declared no conflicts of interest.