J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 The Korean Surgical Society 10.4174/jkss.2009.76.5.293 Original Article Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer Lee Seung Jae M.D. Hwang Seung Oook M.D. Jung Jin Hyang M.D. Park Ho Yong M.D. Lee Jun Hyuk M.D. Eun Young A M.D. Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea. phy123@mail.knu.ac.kr 05 2009 06 05 2009 76 5 293 300 12 02 2009 05 03 2009 Copyright © 2009 The Korean Surgical Society 2009 Purpose

Isolated local recurrence (ILR) after mastectomy is associated with increased risk of cancer-specific survival. This study evaluated the long-term survival and prognostic factors after ILR.

 Methods

Between January 1988 and December 2004, 1,169 patients with early breast cancer (stage I or II) were treated with modified radical mastectomy at Kyungpook hospital. Retrospectively, 40 patients with isolated local recurrence (ILR) were found by medical records and we investigated their clinicopathologic factors and conducted analyses of prognostic factors, calculated overall survival, and relapse-free survival.

 Results

The median follow-up times after initial operation and ILR were each 91 (range, 18~219) months and 40 (range, 1~205) months. There were 18 patients of 2nd recurrence and 15 expired by distant metastasis. The overall survivals at 5 years and 10 years after ILR were 65% and 49%. The relapse-free survivals at 5 years and 10 years after ILR were 54% and 29%. After 2nd recurrence, the mean survival time was 21 months and the 3-year overall survival rate was 21%. By univariate and multivariate analyses, the time interval between initial operation and ILR was only statistically significant independent prognostic factor of overall survival after ILR. The 10 year-overall survival rates of ≤24 months and >24 months to ILR were each 26% and 70%. There was no independent prognostic factor of relapse-free survival after ILR.

 Conclusion

For patients who developed isolated local recurrence after modified radical mastectomy for early breast cancer, shorter time interval to ILR is a poor prognostic factor of overall survival after ILR.

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Annual frequency (A) and cumulative percent (B) of isolated local recurrence after 1st curative operation.

Overall survival curve (A) and relapse-free survival curve (B) after isolated local recurrence.

Overall survival curve after 2nd recurrence.

Overall survival curves after isolated local recurrence (ILR) according to status of time interval from 1st curative operation to ILR (>24 month vs. ≤24 month). *P value was estimated by log rank test.

Status of 1st recurrence

*ILR = isolated local recurrence.

Patient characteristics of isolated local recurrence patients (n=40)

*IDC = invasive ductal carcinoma; †ILC = invasive lobular carcinoma; ‡Time interval = time interval from 1st curative operation to isolated local recurrence.

Treatments of isolated local recurrence

*RT = radiation therapy; †Systemic = chemotherapy or hormonal therapy; ‡Local = local wide excision.

Status of 2nd recurrence after isolated local recurrence

*IAX = ipsilateral axillary lymph node; †ISCLN = ipsilateral supraclaviclar lymph node; ‡IRN = ipsilateral Rotter's node.

Univariate and multivariate Cox's proportional hazards regression model for overall survival and relapse-free survival after isolated local recurrence according to prognostic factors

*ILR = isolated local recurrence; †hazard ratio=54.6, 95% confidence interval=1.4~2,094.6.