In total, 98 cases developed AFR; 13 LRR with synchronous DM, 39 LRR without DM, and 46 DM only. Additional two DM was reported after the first recurrence, and the total cases of DM were 61. The cumulative rates for AFR at 5, 7 and 10 years were 5.3%, 6.7% and 7.9%, respectively. On univariate analysis (Table 2), an age of ≤ 40 years (p < 0.001), T2 stage (p < 0.001), a high tumor grade (p = 0.011), and biological subtype (p < 0.001) were significantly associated with a high risk of AFR. With respect to the biologic subtype, the 7-year cumulative incidence of AFR was 4.4% for luminal A, 13.9% for luminal B, 8.2% for luminal HER2, 7.2% for HER2+, and 9.1% for TN (p < 0.001). The use of trastuzumab in patients with HER2 and luminal HER2 subtypes was not associated with AFR (Table 2). To facilitate comparison between the groups in the multivariate analysis, these five subtypes were redefined as binary variables based on the results of the univariate analysis: TN tumors and others (p = 0.006). The use of chemotherapy was significantly associated with a high risk of AFR (p = 0.017), and this was attributed to the development of DM as a first recurrence. On multivariate analysis (Table 3), an age of ≤ 40 years (HR, 2.6; p < 0.001), T2 stage (HR, 1.3; p < 0.001), and the TN biological subtype (HR, 1.6; p = 0.045) were independently associated with a high risk of AFR.