Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer

Seung Jae Lee; Seung Oook Hwang; Jin Hyang Jung; Ho Yong Park; Jun Hyuk Lee; Young A Eun

doi:10.4174/jkss.2009.76.5.293

Journal List > J Korean Surg Soc > v.76(5) > 1010957

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Hwang, Jung, Park, Lee, and Eun: Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer

Original Article

Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 76(5): 293-300.

Published online: 6 May 2009

DOI: https://doi.org/10.4174/jkss.2009.76.5.293

Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer

Seung Jae Lee, M.D., Seung Oook Hwang, M.D., Jin Hyang Jung, M.D., Ho Yong Park, M.D., Jun Hyuk Lee, M.D., Young A Eun, M.D.

Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.

phy123@mail.knu.ac.kr

Received 12 February 2009 Accepted 5 March 2009

Abstract

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.

Keywords: Breast cancer, Local recurrence, Prognosis

Figures and Tables

Fig. 1

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

Fig. 2

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

Fig. 3

Overall survival curve after 2nd recurrence.

Fig. 4

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

Table 1

Status of 1st recurrence

^*ILR = isolated local recurrence.

Table 2

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.

Table 3

Treatments of isolated local recurrence

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

Table 4

Status of 2nd recurrence after isolated local recurrence

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

Table 5

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.

References

1. Veronesi U, Marubini E, Del Vecchio M, Manzari A, Andreola S, Greco M, et al. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst. 1995. 87:19–27.

2. Kamby C, Sengelov L. Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer. A prospective study with more than 10 years of follow up. Breast Cancer Res Treat. 1997. 45:181–192.

3. Haffty BG, Reiss M, Beinfield M, Fischer D, Ward B, McKhann C. Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol. 1996. 14:52–57.

4. Clemons M, Danson S, Hamilton T, Goss P. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev. 2001. 27:67–82.

5. Son BH, Lee PC, Yoon HS, Kwak HS, Lee KC, Kim CS, et al. Patterns of locoregional and systemic failure after a mastectomy in breast cancer and risk factors predicting failure. J Korean Surg Soc. 2000. 59:305–312.

6. Lee JB, Kim DH, Min BW, Ryu KW, Um JW, Kim AR, et al. Factors influencing the recurrence of breast cancer following modified radical mastectomy. J Korean Breast Cancer Soc. 2001. 4:128–135.

7. van Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet F, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer. 1999. 35:32–38.

8. Fodor J, Major T, Polgar C, Orosz Z, Sulyok Z, Kasler M. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast. 2008. 17:302–308.

9. Son BH, Ahn SH, Kwak BS, Kim JK, Kim HJ, Hong SJ, et al. The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer. J Breast Cancer. 2006. 9:134–144.

10. Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999. 17:1689–1700.

11. Greene FL, editor. American Joint Committee on Cancer. American Cancer Society. AJCC cancer staging manual. 2002. 6th ed. New York: Springer.

12. Kim JK, Son BH, Kwak BS, Hwang UK, Kim HJ, Lee JS, et al. Surgical treatment of locoregional recurrence in breast cancer. J Breast Cancer. 2006. 9:241–248.

13. Recht A, Schnitt SJ, Connolly JL, Rose MA, Silver B, Come S, et al. Prognosis following local or regional recurrence after conservative surgery and radiotherapy for early stage breast carcinoma. Int J Radiat Oncol Biol Phys. 1989. 16:3–9.

14. Andry G, Suciu S, Vico P, Faverly D, Andry-t'Hooft M, Verhest A, et al. Locoregional recurrences after 649 modified radical mastectomies: incidence and significance. Eur J Surg Oncol. 1989. 15:476–485.

15. Haffty BG, Fischer D, Beinfield M, McKhann C. Prognosis following local recurrence in the conservatively treated breast cancer patient. Int J Radiat Oncol Biol Phys. 1991. 21:293–298.

16. Bedwinek JM, Lee J, Fineberg B, Ocwieza M. Prognostic indicators in patients with isolated local-regional recurrence of breast cancer. Cancer. 1981. 47:2232–2235.

17. Le MG, Arriagada R, Spielmann M, Guinebretiere JM, Rochard F. Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma. Cancer. 2002. 94:2813–2820.

18. Janni W, Shabani N, Dimpfl T, Starflinger I, Rjosk D, Peschers U, et al. Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow up. J Cancer Res Clin Oncol. 2001. 127:455–462.

19. Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J. 2002. 8:81–87.

20. Clemons M, Hamilton T, Goss P. Does treatment at the time of locoregional failure of breast cancer alter prognosis? Cancer Treat Rev. 2001. 27:83–97.

21. Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. 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. 79:147–155.

TOOLS

Similar articles