Predictors of systemic recurrence and disease‐specific survival after ipsilateral breast tumor recurrence

• Published in: Cancer Vol. 104; no. 3; pp. 479 - 490
• Main Authors: Shen, Jeannie, Hunt, Kelly K., Mirza, Nadeem Q., Buchholz, Thomas A., Babiera, Gildy V., Kuerer, Henry M., Bedrosian, Isabelle, Ross, Merrick I., Ames, Frederick C., Feig, Barry W., Singletary, S. Eva, Cristofanilli, Massimo, Meric‐Bernstam, Funda
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2005; Wiley-Liss
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; breast carcinoma; Breast Neoplasms - diagnosis; Breast Neoplasms - mortality; Carcinoma in Situ - diagnosis; Carcinoma in Situ - mortality; Carcinoma, Ductal, Breast - diagnosis; Carcinoma, Ductal, Breast - mortality; Carcinoma, Lobular - diagnosis; Carcinoma, Lobular - mortality; Combined Modality Therapy; Disease-Free Survival; Female; Gynecology. Andrology. Obstetrics; Humans; ipsilateral breast tumor recurrence; Lymph Nodes - pathology; Mammary gland diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - mortality; Neoplasm Staging; predictors; survival; systemic recurrence; Tumors; predictors; Relapse; Breast disease; Breast tumor; systemic recurrence; Survival; Mammary gland diseases; Ipsilateral; Cancerology; breast carcinoma; Systemic disease; ipsilateral breast tumor recurrence; Predictive factor
• DOI: 10.1002/cncr.21224
• ISSN: 0008-543X

BACKGROUND In patients with breast carcinoma, ipsilateral breast tumor recurrence (IBTR) after breast‐conserving therapy (BCT) is an independent predictor of systemic recurrence and disease‐specific survival (DSS). However, only a subgroup of patients with IBTR develop systemic recurrences. Therefore, the management of isolated IBTR remains controversial. The objective of the current study was to identify determinants of systemic recurrence and DSS after IBTR. METHODS The medical records of 120 women who underwent BCT for Stage 0–III breast carcinoma between 1971 and 1996 and who subsequently developed isolated IBTR were reviewed. Clinicopathologic factors were studied using univariate and multivariate analyses for their association with DSS and the development of systemic recurrence after IBTR. RESULTS The median time to IBTR was 59 months. At a median follow‐up of 80 months after IBTR, 45 patients (37.5%) had a systemic recurrence. Initial lymph node status was the strongest predictor of systemic recurrence according to the a univariate analysis (P = 0.001). Other significant factors included lymphovascular invasion (LVI) in the primary tumor, time to IBTR ≤ 48 months, clinical and pathologic IBTR tumor size > 1 cm, LVI in the recurrent tumor, and skin involvement at IBTR. In a multivariate logistic regression analysis, initially positive lymph node status (relative risk [RR], 5.3; 95% confidence interval [95% CI], 1.4–20.1; P = 0.015) and skin involvement at IBTR (RR, 15.1; 95% CI, 1.5–153.8; P = 0.022) remained independent predictors of systemic recurrence. The 5‐year and 10‐year DSS rates after IBTR were 78% and 68%, respectively. In a multivariate Cox proportional hazards model analysis, only LVI in the recurrent tumor was found to be an independent predictor of DSS (RR, 4.6; 95% CI, 1.5–14.1; P = 0.008). CONCLUSIONS Patients who initially had lymph node‐positive disease or skin involvement or LVI at IBTR represented especially high‐risk groups that warranted consideration for aggressive, systemic treatment and novel, targeted therapies after IBTR. Determinants of prognosis after IBTR should be taken into account when evaluating the need for further systemic therapy and designing risk‐stratified clinical trials. Cancer 2005. © 2005 American Cancer Society. The management of patients with ipsilateral breast tumor recurrences (IBTR) remains controversial. In this study, the authors found that initial lymph node‐positive disease and skin involvement or lymphovascular invasion at IBTR were independent predictors of poor outcome after IBTR.