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1112 Background: In recurred breast cancer (BC) with isolated lung metastasis, the role of pulmonary metastasectomy (PM) is not established. Methods: We consecutively enrolled recurred BC patients (pts) with isolated lung metastasis from 1997 to 2007 in Seoul National University Hospital. Among 140 recurred pts with isolated lung metastasis, 45 had metastatic lesions less than 4. We analyzed the clinical outcomes of these 45 pts. Results: The median age was 49.0 (range 32–67) years. The median disease-free interval (DFI, Time from initial BC diagnosis to recur) was 26.1 (range 4.2–168.0) months, and the pts with DFI of less than 24 months were 20 (44%). The pts who had biologic subtypes (BS) of hormone receptor (HR)(+), HER-2(+), triple negative (TN) were 16 (36%), 14 (31%,) and 15 (33%), respectively. Fifteen (33%) had PM then followed by systemic treatment (PM group), and 30 received systemic treatment without PM (no PM group). There was no difference in terms of clinical factors such as DFI and BS between two groups. The median progression-free survival (PFS) and overall survival (OS) were 13.0 months (95% CI, 10.05–15.95) and 41.7 months (95% CI, 23.82–59.58), respectively. In univariate analysis, PFS was significantly longer in pts with PM (p < 0.001), DFI of more than 24 months (p < 0.001), and was marginally significant according to BS (p = 0.084). In multivariate analysis, DFI of less than 24 months (hazard ratio [H], 4.53; 95% CI, 1.72–11.90), no PM (H, 9.52; 95% CI, 3.34–27.18) and BS such as HER-2(+) (H, 3.00; 95% CI, 1.04–8.64) and TN (H, 3.92; 95% CI, 1.32–11.59) were independent prognostic factors for shorter PFS. In univariate analysis, OS was significantly longer in pts with PM (p = 0.011), DFI of more than 24 months (p < 0.001), HR(+) BS (p = 0.009). In multivariate analysis, DFI of less than 24 months (H, 7.67; 95% CI, 2.00–29.43) and BS such as HER-2(+) (H, 3.70; 95% CI, 1.03–13.24) and TN (H, 3.27; 95% CI, 1.02–10.44) were independent prognostic factors for shorter OS. Conclusions: In recurred BC with isolated, limited number (less than 4) of lung metastasis, DFI and BS were prognostic factors for PFS and OS. PM also prolonged PFS, and, for OS, more follow-up is needed. Further prospective studies to define the role of PM are warranted. No significant financial relationships to disclose.

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Prognostic value of p53 and bcl-2 expression on treatment outcome in breast cancer patients has been extensively evaluated, but the results were inconclusive. We evaluated the prognostic significance of these molecular markers in patients treated with breast conserving surgery and radiotherapy. One hundred patients whose immunostaining of p53 and bcl-2 expression was available among 125 patients who underwent radiotherapy after breast conserving surgery and axillary lymph node dissection were enrolled into this study. Eighty-seven patients also received adjuvant chemotherapy and/or hormonal therapy. Conventional clinicopathologic variables and treatment-related factors were also considered. The 5-yr loco-regional relapse-free and distant metastasis-free survival rates were 91.7% and 90.9%, respectively. On univariate analysis, age, T stage and the absence of bcl-2 & estrogen receptor (ER) expression were associated with loco-regional relapse-free survival. When incorporating these variables into Cox proportional hazard model, only bcl-2(-)/ER(-) phenotype was an adverse prognostic factor (P=0.018). As for the distant metastasis-free survival, age, T stage, and p53 expression were significant on univariate analysis. However, p53 expression was the only prognosticator on multivariate analysis (P=0.009). A bcl-2(-)/ER(-) phenotype and p53 expression are useful molecular markers predicting loco-regional relapse-free and distant metastasis-free survival, respectively, in patients treated with breast conserving surgery and radiotherapy.

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