We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy.

374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0.

Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in locoregionally recurred patients and 30.0% in systematically recurred patients respectively (p=O.OO). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-regional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy.

The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.