Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2016 | Research

Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery

Authors: Mostafa Elsayed, Mahmoud Alhussini, Ahmed Basha, A. T. Awad

Published in: World Journal of Surgical Oncology | Issue 1/2016

Login to get access

Abstract

Background

A number of patients treated conservatively for breast cancer will develop loco-regional and distant recurrences. Our aim was to determine how their occurrence may be linked to the evolution of the disease.

Methods

We analyzed 238 women treated by conservative breast surgery and breast irradiation in a single institution. We evaluated the prognostic factors associated with loco-regional and distant recurrences and the prognostic value of local and regional recurrences on systemic progression.

Results

After a median follow-up of 5 year (range 1–10), 16 (6.72 %) patients in the breast conservative surgery (BCS) groups had loco-regional recurrence. For distant recurrence, 10 (4.2 %) patients had experienced distant recurrence. Lympho-vascular invasion (HR 2.55; 95 % CI, 076 to 8.49) and an extensive intraductal component (HR, 2.22; 95 % CI, 0.69 to 7.15) and nodal status are risk factors for loco-regional recurrence (LRR) after breast conservative therapy (BCT). Tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years) are correlated with higher distant recurrence rates after BCT.

Conclusions

Risk factors for LRR after BCS include lympho-vascular invasion, extensive inraductal component, and high nodal status, where as risk factors for distant recurrence include tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years).
Literature
1.
go back to reference 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;347:1233–41.CrossRefPubMed 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;347:1233–41.CrossRefPubMed
2.
go back to reference 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;347:1227–32.CrossRefPubMed 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;347:1227–32.CrossRefPubMed
3.
go back to reference Goh BK, Yong WS. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2004;100:1766.CrossRefPubMed Goh BK, Yong WS. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2004;100:1766.CrossRefPubMed
4.
go back to reference 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;92:1143–50.CrossRefPubMed 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;92:1143–50.CrossRefPubMed
5.
go back to reference Komoike Y, Akiyama F, Iino Y, et al. Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer. 2006;106:35–41.CrossRefPubMed Komoike Y, Akiyama F, Iino Y, et al. Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer. 2006;106:35–41.CrossRefPubMed
6.
go back to reference Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–37.CrossRefPubMed Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–37.CrossRefPubMed
7.
go back to reference Mamounas EP. Ipsilateral breast tumor recurrence after lumpectomy: is it time to take the bull by the horns? J Clin Oncol. 2001;19:3798–800.PubMed Mamounas EP. Ipsilateral breast tumor recurrence after lumpectomy: is it time to take the bull by the horns? J Clin Oncol. 2001;19:3798–800.PubMed
8.
go back to reference Shen J, Hunt KK, Mirza NQ, et al. Predictors of systemic recurrence and disease-specific survival after ipsilateral breast tumor recurrence. Cancer. 2005;104:479–90.CrossRefPubMed Shen J, Hunt KK, Mirza NQ, et al. Predictors of systemic recurrence and disease-specific survival after ipsilateral breast tumor recurrence. Cancer. 2005;104:479–90.CrossRefPubMed
9.
go back to reference de Bock GH, Putter H, Bonnema J, et al. The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model. Breast Cancer Res Treat. 2009;117:401–8.CrossRefPubMed de Bock GH, Putter H, Bonnema J, et al. The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model. Breast Cancer Res Treat. 2009;117:401–8.CrossRefPubMed
10.
go back to reference Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMed Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMed
11.
go back to reference Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27:2466–73.CrossRefPubMedPubMedCentral Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27:2466–73.CrossRefPubMedPubMedCentral
12.
go back to reference Ziogas D, Roukos DH. Genetics and personal genomics for personalized breast cancer surgery: progress and systems biology. Ann Surg. 2009;249:1067–8.CrossRef Ziogas D, Roukos DH. Genetics and personal genomics for personalized breast cancer surgery: progress and systems biology. Ann Surg. 2009;249:1067–8.CrossRef
14.
go back to reference Kim KJ, Huh SJ, Yang JH, et al. Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol. 2005;35:126–33.CrossRefPubMed Kim KJ, Huh SJ, Yang JH, et al. Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol. 2005;35:126–33.CrossRefPubMed
16.
go back to reference Miles RC, Gullerud RE, Lohse CM, et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol. 2012;19:1153–9.CrossRefPubMed Miles RC, Gullerud RE, Lohse CM, et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol. 2012;19:1153–9.CrossRefPubMed
17.
go back to reference Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27:4939–47.CrossRefPubMedPubMedCentral Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27:4939–47.CrossRefPubMedPubMedCentral
18.
go back to reference Werkhoven E, Hart G, Tinteren H, et al. Nomogram to predict ipsilateral breast relapse based on pathology review from the EORTC 22881-10882 boost versus no boost trial. Radiother Oncol. 2011;100:101–7.CrossRefPubMed Werkhoven E, Hart G, Tinteren H, et al. Nomogram to predict ipsilateral breast relapse based on pathology review from the EORTC 22881-10882 boost versus no boost trial. Radiother Oncol. 2011;100:101–7.CrossRefPubMed
19.
go back to reference Bernardi S, Bertozzi S, Londero AP, et al. Influence of surgical margins on the outcome of breast cancer patients: a retrospective analysis. World J Surg. 2014;38:2279–87.CrossRefPubMed Bernardi S, Bertozzi S, Londero AP, et al. Influence of surgical margins on the outcome of breast cancer patients: a retrospective analysis. World J Surg. 2014;38:2279–87.CrossRefPubMed
20.
go back to reference Voogd AC, Nielsen M, Peterse JL, et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer. Pooled results of two large European randomized trials. J Clin Oncol. 2001;19:1688–97.PubMed Voogd AC, Nielsen M, Peterse JL, et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer. Pooled results of two large European randomized trials. J Clin Oncol. 2001;19:1688–97.PubMed
21.
go back to reference Alrahbi S, Chan PM, Ho BC, Seah MD, Chen JJ, Tan EY. Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer. Clin Breast Cancer. 2015;15:219–26.CrossRefPubMed Alrahbi S, Chan PM, Ho BC, Seah MD, Chen JJ, Tan EY. Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer. Clin Breast Cancer. 2015;15:219–26.CrossRefPubMed
22.
go back to reference Mohammed ZM, McMillan DC, Edwards J, Mallon E, Doughty JC, Orange C, et al. The relationship between lymphovascular invasion and angiogenesis, hormone receptors, cell proliferation and survival in patients with primary operable invasive ductal breast cancer. BMC Clin Pathol. 2013;13:31.CrossRefPubMedPubMedCentral Mohammed ZM, McMillan DC, Edwards J, Mallon E, Doughty JC, Orange C, et al. The relationship between lymphovascular invasion and angiogenesis, hormone receptors, cell proliferation and survival in patients with primary operable invasive ductal breast cancer. BMC Clin Pathol. 2013;13:31.CrossRefPubMedPubMedCentral
23.
go back to reference Ejlertsen B, Jensen MB, Rank F, Rasmussen BB, Christiansen P, Kroman N, et al. Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. J Natl Cancer Inst. 2009;101:729–35.CrossRefPubMed Ejlertsen B, Jensen MB, Rank F, Rasmussen BB, Christiansen P, Kroman N, et al. Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. J Natl Cancer Inst. 2009;101:729–35.CrossRefPubMed
24.
go back to reference Van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer. 1992;28A:801–5.CrossRefPubMed Van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer. 1992;28A:801–5.CrossRefPubMed
25.
go back to reference Nielsen HM, Overgard M, Grau C, et al. Loco-regional recurrence after mastectomy in high-risk breast cancer—risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol. 2006;79:147–55.CrossRefPubMed Nielsen HM, Overgard M, Grau C, et al. Loco-regional recurrence after mastectomy in high-risk breast cancer—risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol. 2006;79:147–55.CrossRefPubMed
26.
go back to reference Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13:412–9.CrossRefPubMed Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13:412–9.CrossRefPubMed
27.
go back to reference Ohsumi S, Sakamoto G, Takashima S, Koyama H, Shin E, Suemasu K, et al. Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation. Jpn J Clin Oncol. 2003;33:61–7.CrossRefPubMed Ohsumi S, Sakamoto G, Takashima S, Koyama H, Shin E, Suemasu K, et al. Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation. Jpn J Clin Oncol. 2003;33:61–7.CrossRefPubMed
28.
go back to reference Mechera R, Viehl CT, Oertli D. Factors predicting in-breast tumor recurrence after breast-conserving surgery. Breast Cancer Res Treat. 2009;116:171–7.CrossRefPubMed Mechera R, Viehl CT, Oertli D. Factors predicting in-breast tumor recurrence after breast-conserving surgery. Breast Cancer Res Treat. 2009;116:171–7.CrossRefPubMed
29.
go back to reference Lundin J, Lundin M, Holli K, et al. Omission of histologic grading from clinical decision making may result in overuse of adjuvant therapies in breast cancer: results from a nationwide study. J Clin Oncol. 2001;19:28–36.PubMed Lundin J, Lundin M, Holli K, et al. Omission of histologic grading from clinical decision making may result in overuse of adjuvant therapies in breast cancer: results from a nationwide study. J Clin Oncol. 2001;19:28–36.PubMed
30.
go back to reference Kunkler IH, Kerr GR, Thomas JS, et al. Impact of screening and risk factors for local recurrence and survival after conservative surgery and radiotherapy for early breast cancer: results from a large series with long-term follow-up. Int J Radiat Oncol, Biol, Phys. 2012;83:829–38.CrossRef Kunkler IH, Kerr GR, Thomas JS, et al. Impact of screening and risk factors for local recurrence and survival after conservative surgery and radiotherapy for early breast cancer: results from a large series with long-term follow-up. Int J Radiat Oncol, Biol, Phys. 2012;83:829–38.CrossRef
31.
go back to reference Kato T, Kameoka S, Kimura T, et al. Angiogenesis as a predictor of long-term survival for 377 Japanese patients with breast cancer. Breast Cancer Res Treat. 2001;70:65–74.CrossRefPubMed Kato T, Kameoka S, Kimura T, et al. Angiogenesis as a predictor of long-term survival for 377 Japanese patients with breast cancer. Breast Cancer Res Treat. 2001;70:65–74.CrossRefPubMed
32.
go back to reference Choi WW, Lewis MM, Lawson D, et al. Angiogenic and lymphangiogenic microvessel density in breast carcinoma: correlation with clinicopathologic parameters and VEGF-family gene expression. Mod Pathol. 2005;18:143–52.CrossRefPubMed Choi WW, Lewis MM, Lawson D, et al. Angiogenic and lymphangiogenic microvessel density in breast carcinoma: correlation with clinicopathologic parameters and VEGF-family gene expression. Mod Pathol. 2005;18:143–52.CrossRefPubMed
33.
go back to reference Erdem O, Dursun A, Coşkun U, et al. The prognostic value of p53 and c-erbB-2 expression, proliferative activity and angiogenesis in node-negative breast carcinoma. Tumori. 2005;91:46–52.PubMed Erdem O, Dursun A, Coşkun U, et al. The prognostic value of p53 and c-erbB-2 expression, proliferative activity and angiogenesis in node-negative breast carcinoma. Tumori. 2005;91:46–52.PubMed
34.
go back to reference Martinez-Ramos D, Escrig J, Torrella A, et al. Risk of recurrence of non-metastatic breast cancer in women under 40 years: a population-registry cancer study in a European country. Breast J. 2012;18:118–23.CrossRefPubMed Martinez-Ramos D, Escrig J, Torrella A, et al. Risk of recurrence of non-metastatic breast cancer in women under 40 years: a population-registry cancer study in a European country. Breast J. 2012;18:118–23.CrossRefPubMed
35.
go back to reference van der Leij F, Elkhuizen PH, Bartelink H, et al. Predictive factors for local recurrence in breast cancer. Semin Radiat Oncol. 2012;22:100–7.CrossRefPubMed van der Leij F, Elkhuizen PH, Bartelink H, et al. Predictive factors for local recurrence in breast cancer. Semin Radiat Oncol. 2012;22:100–7.CrossRefPubMed
Metadata
Title
Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery
Authors
Mostafa Elsayed
Mahmoud Alhussini
Ahmed Basha
A. T. Awad
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-0881-x

Other articles of this Issue 1/2016

World Journal of Surgical Oncology 1/2016 Go to the issue