Relapse of breast cancer after adjuvant treatment in premenopausal and perimenopausal women: patterns and prognoses

Eight hundred eighteen premenopausal or perimenopausal breast cancer patients with axillary node metastases were treated with adjuvant chemotherapy (CMF) with or without endocrine treatment (prednisone, oophorectomy) in two concurrent prospective trials. Three hundred fifty-two (43%) had recurrent disease at a median follow-up time of 6 years. The 2-year survival percentages from time of first relapse were 16% for patients with initial metastases in visceral or multiple sites (including bone and soft tissue), 41% for those with regional metastases or skeletal relapse alone and 70% for patients with isolated local recurrence or contralateral breast cancer. The features that most influenced prognosis within the categories defined by site of first relapse were disease-free interval (less than 24 months v greater than or equal to 24 months), and estrogen receptor content in the primary tumor. These features had clinical importance (identifying patients with at least a 50% 2-year survival percentage) only in those patients with local, contralateral breast, regional, or bony disease alone. The treatment of individual patients after relapse must be directed toward optimized palliation. The results of this study are important for defining groups of patients who relapse after CMF for whom the subsequent therapeutic approach might be differentiated (eg, experimental treatments for dire prognosis, accent on minimal side effect treatment for intermediate prognosis, and investigation of adjuvant systemic therapy for isolated local recurrence).