Prognostic factors in patients with isolated recurrences of breast cancer (stage IV-NED)

Background: One to 10% of women with metastatic breast cancer have a recurr ence of their disease as an isolated lesion (local, regional, or distant) w hich may be treated by surgical resection, irradiation, or both. These are patients with stage IV breast cancer with no evidence of disease, or stage IV-NED. Because natural history and prognostic factors for patients with st age IV-NED are poorly determined, we decided to evaluate a group of patient s with stage IV-NED treated at a single institution. Patients and methods: Ninety-six patients with isolated recurrence of stage IV breast cancer were analyzed retrospectively. Treatment of loco-regional or distant recurrence was surgery in 18 patients and surgery plus irradiat ion in 78 patients. Seventy-nine patients received systemic therapy after l oco-regional treatment (24 chemotherapy and 55 hormonotherapy). Prognostic factors were analyzed and correlated with disease-free survival (DFS) and o verall survival (OS). Results: Five-year DFS and OS for the whole group were 29% and 49%, respect ively. On the univariate analysis, patients without axillary nodal involvem ent at the time of mastectomy had significantly greater 5-year DFS and OS t han patients with nodal involvement (51% vs. 14% and 70% vs. 34%, respectiv ely, p < 0.05). DFS was also significantly better for patients receiving sy stemic therapy after local treatment (31% vs. 19%). On the multivariate ana lysis, absence of nodal involvement and systemic therapy were associated wi th longer DFS (p = 0.044 and p = 0.008, respectively) and OS (p = 0.009 and p = 0.011, respectively). None of the other factors analyzed including men opausal status, T-stage, number of involved nodes, receptor status, adjuvan t therapy, sites of first recurrence, or time from mastectomy to first recu rrence had a predictive value for DFS and OS. Conclusion: Patients with stage IV-NED have poor prognosis due to early dev elopment of metastatic disease. Absence of axillary nodal involvement at th e time of mastectomy and systemic therapy following local management is ass ociated with improved DFS and OS. These results suggest that systemic thera py after local treatment in stage IV-NED is indicated. Poor prognosis in pa tients with previous nodal involvement warrants new approaches.