RELATIONSHIP BETWEEN THE STATUS clinicopathologic BREAST CANCER PATIENTS UNDERGOING OPERATION WHICH operable radical mastectomy with recurrences LOKOREGIONAL MODIFICATIONS IN Hospital Dr. Sardjito 2010
ABSTRACT: Background : Breast cancer emerges as the highest incident cancer in Indonesia. Mortality of breast cancer reaches up to 19,750 of 48,998 cases (40.31%) in 2012. Locoregional recurrence usually develops 2-3 year after operation. Recurrence incidence rate in Indonesia is very high affecting 20.2% of total breast cancer cases. Several factors are identified to play a role in the breast cancer recurrence, including age, tumor size, tumor stadium, lymph nodes status, histopathology grade, estrogen receptor, progesterone receptor, and HER-2/neu immunohistochemical subtypes. Objective: To identify the most recent variables involved in the locoregional recurrence of operable breast cancer after modified radical mastectomy and adjuvant chemotherapy. Subject: Patients with operable breast cancer who underwent a modified radical mastectomy in Dr Sardjito hospital on January until December 2010 and met the inclusion criteria. Methods: We used descriptive non-experimental study with a retrospective cohort design involving 109 patients with operable breast cancer treated in Dr Sardjito hospital Januari-December 2010. Chi-square test and multivariate analysis with logistic regression were used to determine clinicopathologic factors involved in the high recurrence rate of breast cancer in Indonesia. Results: In our cohort, we identified locoregional recurrence in 18 of 109 breast cancer patients (16.51%). Clinicopathologic factors that significantly affect the incidence of recurrence were tumor stadium (Breast cancer stadium IIIB vs IIIA, p=0,006, OR 2,62). Tumor grade (grade 1 vs grade 3, p=0,039, OR 3,6), and Her2/neu (Positive vs negative, p=0,037, OR 0,22). In addition, subtype of breast cancer using immunohistochemitry showed that triple negative increased recurrence rate in comparison to luminal B (p=0,009, OR 4,2). Multivariate analysis using logistic regression showed that immunohistochemical subtype was the most dominant factor influencing recurrence rate (p=0,041), particulary in triple negative breast cancer (p=0,047). Conclusion: In our study, clinicopathological variables affecting locoregional recurrence of breast cancer were tumor stadium, histopathological grading, and HER-2/neu immunohistochemical subtypes. The most dominant factor affecting the incidence of recurrence was subtype of immunohistochemistry (triple negative
