Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors

Ji Hoon Kim; Wonshik Han; Hyeong-Gon Moon; Eunyoung Ko; Jong Won Lee; Eun-Kyu Kim; In-Ae Park; Sung Whan Ha; Eui Kyu Chie; Seung Keun Oh; Yeo-Kyu Youn; Sung-Won Kim; Ki-Tae Hwang; Dong-Young Noh

doi:10.4048/jbc.2009.12.4.324

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Kim, Han, Moon, Ko, Lee, Kim, Park, Ha, Chie, Oh, Youn, Kim, Hwang, and Noh: Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors

Original Article

J Breast Cancer 2009;12(4):324-330.

Published online: 31 December 2009

DOI: https://doi.org/10.4048/jbc.2009.12.4.324

Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors

Ji Hoon Kim, Wonshik Han, Hyeong-Gon Moon¹, Eunyoung Ko, Jong Won Lee², Eun-Kyu Kim³, In-Ae Park⁴, Sung Whan Ha⁵, Eui Kyu Chie⁵, Seung Keun Oh, Yeo-Kyu Youn, Sung-Won Kim, Ki-Tae Hwang, Dong-Young Noh

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

¹Department of Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea

²Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea

³Department of Surgery, Korea Institution and Medical Science, Korea Cancer Center Hospital, Seoul, Korea

⁴Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

⁵Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea

E-mail: hanw@snu.ac.kr

Received 21 July 2009 Accepted 22 October 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients.

Methods

The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR.

Results

Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (≤35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a HR of 3.86 (p=0.036; 95% CI, 1.09-13.60).

Conclusion

Younger age at diagnosis (≤35) may be associated with an increased risk of IBTR in patients who underwent BCT.

Keywords: Age factors, Breast neoplasms, Breast conserving therapy, Local neoplasm recurrence

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Fig 1.

Kaplan-Meier survival curves according to patients’ age.

Table 1.

Clinicopathologic information of studied patients

Patient characteristics
Mean age (rank)	45.4 (22-72)
Age (yr)
≤35	31 (10.5%)
>35	263 (89.5%)
T stage
T1	185 (62.9%)
T2	103 (35.0%)
Unknown	6 (2.0%)
Lymph node metastasis
Negative	208 (70.7%)
Positive	84 (28.6%)
Unknown	2 (0.7%)
Nuclear Grade
Low grade	95 (32.4%)
High grade	198 (67.3%)
Unknown	1 (0.3%)
Histologic Grade
Low grade	189 (64.3%)
High grade	105 (35.7%)
EIC
Negative	225 (76.5%)
Positive	62 (21.1%)
Unknown	7 (2.4%)
LVI
Negative	242(82.3%)
Positive	52(17.6%)
Close surgical margin (≤3 mm)
No	264 (82.3%)
Yes	30 (17.7%)
Adjuvant chemotherapy
Yes	206 (70.1%)
No	70 (23.8%)
Unknown	18 (6.1%)
Adjuvant hormone therapy
Yes	176 (59.9%)
No	118 (40.1%)
ER status
Negative	113 (38.4%)
Positive	181 (61.6%)
PR status
Negative	166 (56.5%)
Positive	128 (43.5%)
HER-2
Negative	136 (46.3%)
Positive	94 (32.0%)
Unknown	64 (21.8%)

EIC=Extensive Intraductal Component; LVI=Lymphovascular Invasion; ER=estrogen receptor; PR=progesterone receptor.

Table 2.

Results of univariate and multivariate analysis for factors affecting ipsilateral breast tumor recurrence

Variable	Category	Univariate analysis	Multivariate analysis
Variable	Category	p-value	RR	95% CI	p-value
Age group	≤35 vs >35	0.006	3.86	1.09-13.60	0.036
Histologic grade	High vs Low	0.099	2.03	0.57-7.27	0.274
T stage	T2 vs T1	0.443
Lymph node	Positive vs Negative	0.635
AJCC stage	Stage I, II, and III	0.209
Nuclear grade	Grade 3 vs Grade 1,2	0.881
LVI	Present vs Absent	0.095
EIC	Present vs Absent	0.342
Surgical margin	Close vs Clear	0.313
ER status	Positive vs Negative	0.402	1.01	0.29-3.56	0.987
PR status	Positive vs Negative	0.667
HER-2 status	Positive vs Negative	0.755
Chemotherapy	Done vs Not done	0.667
TNBC type	TNBC vs Non-TNBC	0.498

AJCC=American Joint Committee on Cancer; EIC=extensive intraductal component; LVI=lymphovascular invasion; ER=estrogen receptor; PR=progesterone receptor; TNBC=triple negative breast cancer; Non-TNBC=non triple negative breast cancer.

Table 3.

Clinicopathological characteristics of patients according to age at time of diagnosis

	Age ≤35	Age >35	p
T stage
T1	13 (46.4%)	172 (66.2%)	0.060
T2	15 (53.6%)	88 (33.8%)
Nodal metastasis
LN negative	20 (66.7%)	188 (71.8%)	0.532
LN positive	10 (33.3%)	74 (28.2%)
Nuclear grade
Low grade	14 (45.2%)	81 (30.9%)	0.154
High grade	17 (54.8%)	181 (69.1%)
Histologic Grade
Low grade	12 (38.7%)	177 (67.3%)	0.003
High grade	19 (61.3%)	86 (32.7%)
Margin status
Clear margin	26 (83.9%)	238 (90.5%)	0.224
Close margin	5 (16.1%)	25 (9.5%)
Estrogen receptor
Negative	19 (61.3%)	94 (35.7%)	0.010
Positive	12 (38.7%)	169 (64.3%)
HER-2 overexpression
Negative	16 (61.5%)	120 (58.8%)	0.835
Positive	10 (38.5%)	84 (41.2%)
EIC
Absent	27 (93.1%)	198 (76.7%)	0.054
Present	2 (6.9%)	60 (23.3%)
LVI
Absent	21 (67.7%)	221 (84.0%)	0.042
Present	10 (32.3%)	42 (16.0%)

LN=lymph node; EIC=extensive intraductal component; LVI=lymphovascular invasion.

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