Clinical and molecular predictors of very late recurrence in ER-positive breast cancer patients

Risk of recurrence from primary ER-positive breast cancer continues for at least 20 years. A study at Royal Marsden Hospital (London, UK) identified clinical and molecular predictors of recurrence between 10 and 20 years (very late recurrence; VLR). Compared with patients with no recurrence by 20 years, VLR patients had larger tumors and higher node positivity and a higher clinical treatment score at 5 years (CTS5). There was a trend for fewer GATA3 mutations in VLR patients, but no statistically significant differences in mutation frequency. Cell cycle and proliferation genes were strongly expressed in VLR patients. Immune-related genes and cell cycle inhibitors were highly expressed in controls. Neither of these changes were significant after correction for multiple testing. These results were validated in the METABRIC cohort. The authors conclude that clinicopathological features are prognostic beyond 10 years, whereas molecular features which have early prognostic significance, have little prognostic value after 10 years.