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Impact of an In Situ Component on Outcome After In-Breast Tumor Recurrence in Patients Treated with Breast-Conserving Therapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Among all in-breast tumor recurrences (IBTR) following breast-conserving therapy (BCT), some comprise metachronous new primaries (NPs) while others are true recurrences (TRs). Establishing this distinction remains a challenge.

Methods

We studied 3932 women who underwent BCT for stage I–III breast cancer from 1998 to 2008. Of these, 115 (2.9%) had an IBTR. Excluding patients with inoperable/unresectable recurrences or simultaneous distant metastases, 81 patients with isolated IBTR comprised the study population. An IBTR was categorized as an NP rather than a TR if it included an in situ component. The log-rank test and Kaplan–Meier method were used to evaluate disease-free survival (DFS) and overall survival (OS), and univariate and multivariate analyses were performed using Cox proportional hazards regression models.

Results

At a median of 64.5 months from IBTR diagnosis, 28 of 81 patients had DFS events. Five-year DFS was 43.1% in the TR group (p = 0.0001) versus 80.3% in the NP group, while 5-year OS was 59.7% in the TR group versus 91.7% among those with NPs (p = 0.0011). On univariate analysis, increasing tumor size, high grade, positive margins, lymphovascular invasion, node involvement, lack of axillary surgery, chemotherapy, radiation therapy, and IBTR type (TR vs. NP) were significantly associated with worse DFS. Controlling for tumor size and margin status, TRs remained significantly associated with lower DFS (hazard ratio 3.717, 95% confidence interval 1.607–8.595, p = 0.002).

Conclusion

The presence of an in situ component is associated with prognosis among patients with IBTR following BCT and may be useful in differentiating TRs and NPs.

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Disclosure

James Laird, Benjamin Lok, Chun Siu, Hiram Cody, Oren Cahlon, Atif J. Khan, Beryl McCormick, Simon N. Powell, Hannah Yong Wen, Alice Ho, and Lior Z. Braunstein have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    James Laird BS, Benjamin Lok MD, Chun Siu BS, Oren Cahlon MD, Atif J. Khan MD, Beryl McCormick MD, Simon N. Powell MD, PhD & Lior Z. Braunstein MD

  2. New York University School of Medicine, New York, NY, USA

    James Laird BS

  3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hiram Cody MD

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hannah Yong Wen MD, PhD

  5. Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Alice Ho MD

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  1. James Laird BS
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Correspondence to Lior Z. Braunstein MD.

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Laird, J., Lok, B., Siu, C. et al. Impact of an In Situ Component on Outcome After In-Breast Tumor Recurrence in Patients Treated with Breast-Conserving Therapy. Ann Surg Oncol 25, 154–163 (2018). https://doi.org/10.1245/s10434-017-6209-4

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  • DOI: https://doi.org/10.1245/s10434-017-6209-4

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