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Published in:

01-01-2007

Breast Cancer Local Recurrence: Risk Factors and Prognostic Relevance of Early Time to Recurrence

Authors: A. Neri, MD, D. Marrelli, MD, S. Rossi, MD, A. De Stefano, MD, F. Mariani, MD, G. De Marco, MD, S. Caruso, MD, G. Corso, MD, T. Cioppa, MD, E. Pinto, MD, F. Roviello, MD

Published in: World Journal of Surgery | Issue 1/2007

Abstract

Background

Local recurrence occurs in 10%–20% of patients treated with breast-conserving surgery for stage I–II breast cancer. The aim of the present study was to investigate breast cancer local recurrence, potential risk factors, and prognostic impact.

Methods

A total of 503 patients treated with breast-conserving surgery were included in the study. All patients underwent axillary dissection and postoperative radiotherapy, and all patients had negative margins at pathological examination. Median follow-up was 82 months. Local recurrence was classified as early when it occurred within 2 years from surgery. The risk factors for local recurrence and overall survival were estimated by univariate and multivariate analyses.

Results

Forty-six cases (9.1%) of local recurrence were observed, 11 of which occurred within 24 months of surgery; the other 35, sometime later. Statistically significant risk factors for local recurrence were premenopausal status, peritumoral vascular invasion, multifocality, and absence of estrogen receptors. Independent negative prognostic factors for overall survival at 5 and 10 years were N stage, absence of estrogen receptors, and early time to recurrence. Overall survival at 10 years was 10.0% for patients with early recurrence, 87.5% for patients with late recurrence, and 87.9% for patients without recurrence.

Conclusions

None of the studied clinicopathological characteristics alone is a determinant for the choice of surgical treatment. Younger patients treated with breast-conserving surgery should receive aggressive postsurgical treatment and should be followed with an intensive follow-up program when metastatic axillary lymph nodes, negative estrogen receptors, or peritumoral vascular invasion are present.

Omne-Pontén M, Holmberg M, Burns T. Determinants of the psycho-social outcome after operation for breast cancer. Results of a prospective comparative interview study following mastectomy, breast conservation. Eur J Cancer 1993;28A:1062–1067

Arriagada R, Lê MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: Patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996;14:1558–1564PubMed

Blichert-Toft M, Rose C, Anderson JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: Six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992;11:19–25PubMed

Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–1241PubMedCrossRef

Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: The National Cancer Institute Randomized Trial. Cancer 2003;98:697–702PubMedCrossRef

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–1232PubMedCrossRef

van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143–1150PubMedCrossRef

Kini VR, Vicini FA, Frazier R, et al. Mammographic, pathologic, and treatment-related factors associated with local recurrence in patients with early-stage breast cancer treated with breast conserving therapy. Int J Radiat Oncol Biol Phys 1999;43:341–346PubMedCrossRef

Recht A, Silen W, Schnitt SJ, et al. Time-course of local recurrence following conservative surgery and radiotherapy for early-stage breast cancer. Int J Radiat Oncol Biol Phys 1988;15:255–261PubMedCrossRef

10.

Fowble B, Solin LJ, Schultz DJ, et al. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys 1990;19:833–842PubMed

11.

de la Rochefordiere A, Asselain B, Campana F, et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet 1993;341:1039–1042CrossRef

12.

Recht A, Connolly JL, Schnitt SJ, et al. The effect of young age on tumor recurrence in the treated breast after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1988;14:3–10PubMed

13.

Stotter A, Atkinson EN, Fairston BA, et al. Survival following locoregional recurrence after breast conservation therapy for cancer. Ann Surg 1990;212:166–172PubMedCrossRef

14.

Veronesi U, Volerrani F, Luini A, et al. Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer 1990;26:671–673PubMedCrossRef

15.

Ghossein NA, Alpert S, Barba J, et al. Breast cancer. Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively. Arch Surg 1992;127:411–415PubMed

16.

Borger J, Kemperman H, Hart A, et al. Risk factors in breast-conserving therapy. J Clin Oncol 1994;12:653–660PubMed

17.

Kurtz JM, Jacquemier J, Amalric R, et al. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer 1990;65:1867–1878PubMedCrossRef

18.

Clemente CG, Boracchi P, Andreola S, et al. Peritumoral lymphatic invasion in patients with node-negative mammary duct carcinoma. Cancer 1992;69:1396–1403PubMedCrossRef

19.

Clark RM, McCullogh PB, Levine MN, et al. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst 1992;84:683–689PubMedCrossRef

20.

Vicini FA, Recht A, Abner A, et al. Recurrence in the breast following conservative surgery and radiation therapy for early-stage breast cancer. J Natl Cancer Inst Monogr 1992;11:33–39PubMed

21.

Pezner RD, Wagman LD, Ben-Ezra J, et al. Breast conservation therapy: local tumor control in patients with pathologically clear margins who receive 5000 cGy breast irradiation without local boost. Breast Cancer Res Treat 1994;32:261–267PubMedCrossRef

22.

Haffty BG, Fischer D, Rose M, et al. Prognostic factors for local recurrence in the conservatively treated breast cancer patients: a cautious interpretation of the data. J Clin Oncol 1991;9:997–1003PubMed

23.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:1687–1717CrossRef

24.

Maki HS, Hoehn JL. Influence of estrogen receptors on survival and recurrence in patients with breast cancer without lymph node metastases. Arch Surg 1989;124:377–380PubMed

25.

Fisher B, Anderson S, Redmond C, et al. Reanalysis and results after 12 years of followup in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456–1461PubMedCrossRef

26.

Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 1993;328:1587–1591PubMedCrossRef

27.

Harris JR, Connolly JL, Schnitt SJ, et al. Clinical-pathologic study of early breast cancer treated by primary radiation therapy. J Clin Oncol 1983;1:184–189PubMed

28.

Fisher ER, Anderson S, Tan-Chiu E, et al. Fifteen-year prognostic discriminants for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol-06. Cancer 2001;91:1679 –1687PubMedCrossRef

29.

Vicini FA, Kestin L, Huang R, et al. Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 2003;97:910–919PubMedCrossRef

30.

Whelan T, Clark R, Roberts R, et al. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Int J Radiat Oncol Biol Phys 1994;30:11–16PubMed

31.

Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual, 6th edition, New York, Springer-Verlag, 2002

32.

Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995;332:907–911PubMedCrossRef

33.

Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long term results of breast conservation. Cancer 1995;76:259–267PubMedCrossRef

34.

Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumour and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12:888–894PubMed

35.

Nos C, Bourgeois D, Darles C, et al. Conservative treatment of multifocal breast cancer: a comparative study. Bull Cancer 1999;86:184–188PubMed

36.

Marret H, Perrotin F, Bougnoux P, et al. Histologic multifocality is predictive of skin recurrences after conserving treatment of stage I and II breast cancers. Breast Cancer Res Treat 2001;68:1–8PubMedCrossRef

37.

Eberlein TJ, Connolly JL, Schnitt SJ, et al. Predictors of local recurrence following conservative breast surgery and radiation therapy. The influence of tumor size. Arch Surg 1990;125:771–777PubMed

38.

Holland R, Connolly JL, Gelman R, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 1990;8:113–118PubMed

39.

Ferno M. Prognostic factors in breast cancer: a brief review. Anticancer Res 1998;18:2167–2171PubMed

40.

Wallgren A, Bonetti M, Gelber RD, et al. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII. J Clin Oncol 2003;21:1205–1213PubMedCrossRef

41.

Woo CS, Silberman H, Nakamura SK, et al. Lymph node status combined with lymphovascular invasion creates a more powerful tool for predicting outcome in patients with invasive breast cancer. Am J Surg 2002;184:337–340PubMedCrossRef

42.

Haffty BG, Reiss M, Beinfeld M, et al. Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local recurrence. J Clin Oncol 1996, 14:52–57PubMed

43.

van Tienhoven G, Voogd AC, Deterse JL, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and BDCG-82TM). Eur J Cancer 1999;35:32–38PubMedCrossRef

44.

Lyman GH, Kuderer NM, Lyman SL, et al. Menopausal status and the impact of early recurrence on breast cancer survival. Cancer Control 1997;4:335–341PubMed

45.

Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12:888–894PubMed

46.

Demicheli R, Bonadonna G, Hrushesky WJ, et al. Menopausal status dependence of the timing of breast cancer recurrence after surgical removal of the primary tumour. Breast Cancer Res 2004;6:R689–696PubMedCrossRef

47.

Zhou P, Recht A. Young age and outcome for women with early-stage invasive breast carcinoma. Cancer 2004;101:1264–1274PubMedCrossRef

48.

Elkhuizen P, Slooten V, Clahsen P, et al. High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: an EORTC study. J Clin Oncol 2000;18:1075–1083PubMed

Title: Breast Cancer Local Recurrence: Risk Factors and Prognostic Relevance of Early Time to Recurrence
Authors: A. Neri, MD
D. Marrelli, MD
S. Rossi, MD
A. De Stefano, MD
F. Mariani, MD
G. De Marco, MD
S. Caruso, MD
G. Corso, MD
T. Cioppa, MD
E. Pinto, MD
F. Roviello, MD
Publication date: 01-01-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 1/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0097-2

2024 ASCO Annual Meeting

Springer Medicine

Breast Cancer Local Recurrence: Risk Factors and Prognostic Relevance of Early Time to Recurrence

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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