Impact of primary local treatment on the development of distant metastases or death through locoregional recurrence in young breast cancer patients

• Published in: Breast cancer research and treatment Vol. 140; no. 3; pp. 577 - 585
• Main Authors: Bantema-Joppe, E. J., van den Heuvel, E. R., de Munck, L., de Bock, G. H., Smit, W. G. J. M., Timmer, P. R., Dolsma, W. V., Jansen, L., Schröder, C. P., Siesling, S., Langendijk, J. A., Maduro, J. H.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2013; Springer; Springer Nature B.V
• Subjects: Adult; Age; Biological and medical sciences; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer patients; Cancer research; Cancer therapies; Care and treatment; Diseases; Epidemiology; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Lumpectomy; Mammary gland diseases; Mastectomy; Mastectomy, Segmental; Medical sciences; Medicine; Medicine & Public Health; Metastasis; Mortality; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Multivariate Analysis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Oncology; Radiation therapy; Relapse; Risk factors; Surgical techniques; Tumors; Therapy; Young; Mastectomy; Breast conserving therapy; Breast cancer; Radiotherapy; Locoregional recurrence; Human; Relapse; Breast disease; Mortality; Malignant tumor; Metastasis; First line treatment; Mammary gland diseases; Surgery; Death; Mammary gland; Cancer
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-013-2650-7

In this study, we tested the hypothesis whether breast conserving therapy (BCT) compared with mastectomy is associated with a negative outcome in terms of distant metastases or death (DMD) and investigated the relation between locoregional recurrence (LRR) and DMD in young breast cancer (BC) patients. This study included a consecutive series of 536 patients ≤40 years of age at diagnosis with pathological T1N0-3M0 BC, treated between 1989 and 2005. A multistate survival model was used to evaluate the influences of local treatment and LRR on DMD, adjusted for potential prognostic factors. Patients were treated with mastectomy ( N  = 213) or BCT ( N  = 323). Median age at diagnosis was 36.3 years, with a median follow-up of 9.0 years. The 10-year actuarial cumulative incidence of DMD was 30.6 % after mastectomy and 26.3 % after BCT ( P  = 0.04). In total, 81 (15 %) LRRs were observed. After BCT, patients had a threefold higher risk of LRR than after mastectomy (HR 2.9; 95 % CI 1.6–5.3). Patients with LRR had a higher risk of DMD compared with patients without LRR (HR 5.5; 95 % CI 2.1–14.5). However, BCT was not negatively associated with DMD-after-LRR (HR 0.47; 95 % CI 0.2–1.1, BCT vs mastectomy). In conclusion, although LRR significantly affected DMD, the increased risk of LRR after BCT compared with mastectomy did not lead to a worse DMD outcome in BC patients ≤40 years of age.