Pathological and molecular factors associated with local recurrence and/or distant metastases after conservative treatment of breast cancer..

Abdel-Azeez, Ahmad Mostafa; Tohamy, Ahmed Abd Elrehim; Saber, Raafat Ali; Sholkamy, Nada Hussein Ali

doi:10.21608/mjmr.2025.415877.2086

Pathological and molecular factors associated with local recurrence and/or distant metastases after conservative treatment of breast cancer..

Articles in Press

Document Type : Original Article

Authors

¹ Clinical Oncology and Nuclear Medicine Department ,Faculty of medicine , Minia University.

² Department of clinical oncology, Faculty of Medicine, Minia University, Minia, Egypt

³ Clinical Oncology and Nuclear Medicine, El Minia University

⁴ Clinical Oncology and Nuclear Medicine - Faculty of Medicine -Minia University, Egypt.

10.21608/mjmr.2025.415877.2086

Abstract

Background:

Breast-conserving surgery (BCS) has become a standard treatment for early-stage breast cancer, providing survival outcomes comparable to mastectomy. However, local recurrence (LR) and distant metastases (DM) remain important clinical challenges. Identifying risk factors associated with these outcomes is critical to guide patient management and improve prognosis.

Methods:

We conducted a retrospective study of 108 patients who underwent BCS and subsequently developed LR and/or DM between 2017 and 2021 at Minia University Hospital. Collected data included demographic features, tumor size, histological grade, lymphovascular invasion, receptor status (ER, PR, HER2), surgical margins, adjuvant therapies, and follow-up outcomes. The normality of data distribution was tested using the Shapiro–Wilk and Kolmogorov–Smirnov methods.

Results:

During a median follow-up of 43 months, 59.3% of patients developed DM, 33.3% experienced LR, and 7.4% had both. The median progression-free survival (PFS) was 32 months, while the mean ± SD was 39.29 ± 30.55 months. Univariate analysis revealed poorer PFS in patients with a positive family history, higher tumor grade, advanced nodal stage, lymphovascular invasion, HER2 positivity, high Ki-67 index, and ER negativity. Conversely, adjuvant hormonal therapy was associated with improved PFS, highlighting its protective role.

Conclusion:

Our study confirms that several clinicopathological factors significantly influence the risk of recurrence and metastasis following BCS. ER positivity was associated with improved outcomes, while positive family history, higher grade, larger tumor size, nodal involvement, lymphovascular invasion, HER2 positivity, and high Ki-67 index predicted poorer prognosis. These findings emphasize the need for personalized follow-up and therapeutic strategies in high-risk patients.

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