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Isolated ipsilateral local recurrence of breast cancer: predictive factors and prognostic impact

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Abstract

Background

Tumour features associated with isolated invasive breast cancer (BC) ipsilateral local recurrence (ILR) after breast conservative treatment (BCT) and consequences on overall survival (OS) are still debated. Our objective was to investigate these points.

Methods

Patients were retrospectively identified from a cohort of patients who underwent BCT for invasive BC in 16 cancer centres. End-points were ILR rate and OS. The impact of ILR on OS was assessed by multivariate analysis (MVA) for all patients and according to endocrine receptors (ERs) and grade or tumour subtypes.

Results

Of 15,570 patients, ILR rate was 3.1%. Cumulative ILR rates differed according to ERs/grade (ERs+/Grade2: HR 1.42, p = 0.010; ERs+/Grade3: HR 1.41, p = 0.067; ERs−: HR 2.14, p < 0.0001), endocrine therapy (HR 2.05, p < 0.0001) and age < 40-years old (HR 2.28, p = 0.005) in MVA. When MVA was adjusted on tumour subtype, the latter was the only independent factor. OS-after-ILR was significantly different according to ILR-free intervals (HR 4.96 for ILR-free interval between 2 and 5-years and HR 9.00 when < 2-years, in comparison with ≥ 5-years).

Conclusion

ERs/Grade status, lack of endocrine therapy and tumour subtypes predict isolated ILR risk in patients treated with BCT. Short ILR-free-intervals represent a strong pejorative factor for OS. These results may help selecting initial treatment as well as tailoring ILR systemic chemotherapy.

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Abbreviations

ALND:

Axillary LN dissection

BC:

Breast cancer

BCT:

Breast conservative treatment

CI:

Confidence interval

ERs:

Endocrine receptors

HER2:

Human epidermal growth factor 2

HR:

Hazard ratio

IHC:

Immunohistochemistry

ILR:

Ipsilateral local recurrence

ILRFS:

Ipsilateral local recurrence-free survival

LN:

Lymph node

LVI:

Lympho-vascular invasion

OS:

Overall survival

pN:

Pathological node status

RNI:

Regional nodal irradiation

SLNB:

Sentinel lymph node biopsy

TNBC:

Triple negative breast cancer

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Funding

This research did not receive any specific grant from funding agencies in the public. commercial. or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009, Marseille, France

    Gilles Houvenaeghel, Monique Cohen & Eric Lambaudie

  2. Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France

    Alexandre de Nonneville & Anthony Gonçalves

  3. Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France

    Jean-Marc Classe

  4. Institut Curie, 26 rue d’Ulm, 75248, Paris Cedex 05, France

    Fabien Reyal

  5. Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France

    Chafika Mazouni

  6. Centre Léon Bérard, 28 rue Laennec, Lyon, France

    Nicolas Chopin

  7. Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France

    Alejandra Martinez

  8. Hôpital Tenon, 4 rue de la Chine, Paris, France

    Emile Daraï

  9. Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France

    Charles Coutant

  10. Centre Val d’Aurelles, ICM - 208, Avenue des Apothicaires Parc Euromédecine, 34298, Montpellier Cedex 5, France

    Pierre-Emmanuel Colombo

  11. Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France

    Pierre Gimbergues

  12. Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France

    Marie-Pierre Chauvet

  13. Hôpital de Grasse, Chemin de Clavary, Grasse, France

    Anne-Sophie Azuar

  14. Hôpital René Huguenin, 35 rue Dailly, Saint Cloud, France

    Roman Rouzier

  15. Institut Bergonié, 229 Cours de l’Argonne, Bordeaux, France

    Christine Tunon de Lara

  16. Hôpital de la Timone, 264 rue saint pierre, 13005, Marseille, France

    Xavier Muracciole

  17. Hôpital de la Conception, Service de Gynécologie Obstétrique, 147 Boulevard Baille, 13005, Marseille, France

    Aubert Agostini

Authors
  1. Gilles Houvenaeghel
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  2. Alexandre de Nonneville
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  3. Monique Cohen
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  4. Jean-Marc Classe
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  5. Fabien Reyal
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  6. Chafika Mazouni
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  7. Nicolas Chopin
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  8. Alejandra Martinez
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  9. Emile Daraï
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  10. Charles Coutant
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  11. Pierre-Emmanuel Colombo
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  12. Pierre Gimbergues
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  13. Marie-Pierre Chauvet
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  14. Anne-Sophie Azuar
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  15. Roman Rouzier
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  16. Christine Tunon de Lara
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  17. Xavier Muracciole
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  18. Aubert Agostini
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  19. Anthony Gonçalves
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  20. Eric Lambaudie
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Contributions

Study concepts: GH, AN, MC, AG and EL. Study design: GH, AN, MC, AG and EL. Data acquisition: GH, AN, MC, JMC, FR, CM, NC, AM, ED, CC, PEC, PG, MPC, PA, RR, CTL, XM, AA, AG and EL. Quality control of data and algorithms: GH, AN, MC, JMC, FR, CM, NC, AM, ED, CC, PEC, PG, MPC, PA, RR, CTL, XM, AA, AG and EL. Data analysis and interpretation: GH, AN, MC, JMC, FR, CM, NC, AM, ED, CC, PEC, PG, MPC, PA, RR, CTL, XM, AA, AG and EL. Statistical analysis: GH and EL. Manuscript preparation: GH, AN, MC, AG and EL. Manuscript editing: GH, AN, MC, AG and EL. Manuscript review: GH, AN, MC, JMC, FR, CM, NC, AM, ED, CC, PEC, PG, MPC, PA, RR, CTL, XM, AA, AG and EL.

Corresponding author

Correspondence to Gilles Houvenaeghel.

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Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Ethical approval

This work was approved by our institutional review board (IPC—Comité d’Orientation Stratégique). All procedures performed in this study involving human participants were done in accordance with the French ethical standards and with the 2008 Helsinki declaration.

Informed consent

All included patients provided written informed consent before surgery.

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Houvenaeghel, G., de Nonneville, A., Cohen, M. et al. Isolated ipsilateral local recurrence of breast cancer: predictive factors and prognostic impact. Breast Cancer Res Treat 173, 111–122 (2019). https://doi.org/10.1007/s10549-018-4944-2

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  • DOI: https://doi.org/10.1007/s10549-018-4944-2

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