Skip to main content

Advertisement

Log in

Factors predicting in-breast tumor recurrence after breast-conserving surgery

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose: The main objectives of this study were to identify risk factors for local in-breast tumor recurrence after breast-conservation and to evaluate the impact of IBTR (in-breast tumor recurrence) on overall survival. Methods: A total of 335 consecutive patients with 346 invasive and in situ breast cancers were treated with breast conserving therapy. Univariate and multivariate statistical analysis were performed and survival rates were calculated and analyzed using the Kaplan–Meier method. Results: With a median follow-up period of 70.6 months 14 patients (4%) developed an IBTR. Overall survival and the disease-free 8-year actuarial survival of patients were 95% and 93%, respectively. The overall survival of patients with tumour recurrence on any site was significantly shorter than of those without recurrence (64% versus 85% after 8 years of follow-up; P < 0.0001). Similarly, overall survival was significantly reduced in patients with distant metastases compared to all others without distant disease (88% versus 40% after 8 years; P < 0.0001). In contrast, overall survival of patients who experienced IBTR did not differ significantly from the group of patients who never developed IBTR (87% versus 70% after 8 years of follow-up). By univariate analysis, lobular carcinoma, high grade tumours, multifocality, concomitant LCIS and DCIS, the absence of estrogene and progesterone receptor status, as well as R1-status, were significant predictors of IBTR. By multivariate analysis, only R1-status (P < 0.002) and the presence of LCIS around the invasive tumour (P < 0.03) remained as significant factors predicting IBTR. Conclusions: Concomitant lobular carcinomas in situ, as well as R1 surgical status are independent significant risk factors for in breast tumor recurrence after breast conserving therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fisher B, Redmond C, Poisson R et al (1989) Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320(13):822–828

    PubMed  CAS  Google Scholar 

  2. Veronesi U, Salvadori B, Luini A et al (1990) Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. Ann Surg 211(3):250–259

    PubMed  CAS  Google Scholar 

  3. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347(8):567–575. doi:10.1056/NEJMoa020128

    Article  PubMed  Google Scholar 

  4. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232. doi:10.1056/NEJMoa020989

    Article  PubMed  Google Scholar 

  5. Gage I, Schnitt SJ, Nixon AJ et al (1996) Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy 13. Cancer 78(9):1921–1928. doi:10.1002/(SICI)1097-0142(19961101)78:9<1921::AID-CNCR12>3.0.CO;2-#

    Article  PubMed  CAS  Google Scholar 

  6. Smitt MC, Nowels KW, Zdeblick MJ et al (1995) The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 76(2):259–267. doi:10.1002/1097-0142(19950715)76:2<259::AID-CNCR2820760216>3.0.CO;2-2

    Article  PubMed  CAS  Google Scholar 

  7. Wazer DE, Jabro G, Ruthazer R, Schmid C, Safaii H, Schmidt-Ullrich RK (1999) Extent of margin positivity as a predictor for local recurrence after breast conserving irradiation. Radiat Oncol Investig 7(2):111–117. doi:10.1002/(SICI)1520-6823(1999)7:2<111::AID-ROI7>3.0.CO;2-U

    Article  PubMed  CAS  Google Scholar 

  8. Huang E, Buchholz TA, Meric F et al (2002) Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer 95(10):2059–2067. doi:10.1002/cncr.10952

    Article  PubMed  Google Scholar 

  9. Dixon JM, Gregory K, Johnston S, Rodger A (2002) Breast cancer: non-metastatic. Clin Evid 8:1811–1839

    PubMed  Google Scholar 

  10. Kurtz JM (1992) Factors influencing the risk of local recurrence in the breast. Eur J Cancer 28(2–3):660–666. doi:10.1016/S0959-8049(05)80121-2

    Article  PubMed  CAS  Google Scholar 

  11. Elkhuizen PH, van Slooten HJ, Clahsen PC et al (2000) High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: a European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study. J Clin Oncol 18(5):1075–1083

    PubMed  CAS  Google Scholar 

  12. Locker AP, Ellis IO, Morgan DA, Elston CW, Mitchell A, Blamey RW (1989) Factors influencing local recurrence after excision and radiotherapy for primary breast cancer. Br J Surg 76(9):890–894. doi:10.1002/bjs.1800760906

    Article  PubMed  CAS  Google Scholar 

  13. Kurtz JM, Jacquemier J, Amalric R et al (1990) Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer 65(8):1867–1878. doi:10.1002/1097-0142(19900415)65:8<1867::AID-CNCR2820650833>3.0.CO;2-I

    Article  PubMed  CAS  Google Scholar 

  14. Lindley R, Bulman A, Parsons P, Phillips R, Henry K, Ellis H (1989) Histologic features predictive of an increased risk of early local recurrence after treatment of breast cancer by local tumor excision and radical radiotherapy. Surgery 105(1):13–20

    PubMed  CAS  Google Scholar 

  15. Clarke DH, Le MG, Sarrazin D et al (1985) Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys 11(1):137–145

    PubMed  CAS  Google Scholar 

  16. Fisher ER, Land SR, Fisher B, Mamounas E, Gilarski L, Wolmark N (2004) Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: twelve-year observations concerning lobular carcinoma in situ. Cancer 100(2):238–244. doi:10.1002/cncr.11883

    Article  PubMed  Google Scholar 

  17. Fourquet A, Campana F, Zafrani B et al (1989) Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys 17(4):719–725

    PubMed  CAS  Google Scholar 

  18. Boyages J, Recht A, Connolly J et al (1989) Factors associated with local recurrence as a first site of failure following the conservative treatment of early breast cancer. Recent Results Cancer Res 115:92–102

    PubMed  CAS  Google Scholar 

  19. Eberlein TJ, Connolly JL, Schnitt SJ, Recht A, Osteen RT, Harris JR (1990) Predictors of local recurrence following conservative breast surgery and radiation therapy. The influence of tumor size. Arch Surg 125(6):771–775

    PubMed  CAS  Google Scholar 

  20. Jacquemier J, Kurtz JM, Amalric R, Brandone H, Ayme Y, Spitalier JM (1990) An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy. Br J Cancer 61(6):873–876

    PubMed  CAS  Google Scholar 

  21. Rose MA, Henderson IC, Gelman R et al (1989) Premenopausal breast cancer patients treated with conservative surgery, radiotherapy and adjuvant chemotherapy have a low risk of local failure. Int J Radiat Oncol Biol Phys 17(4):711–717

    PubMed  CAS  Google Scholar 

  22. Langer I, Marti WR, Guller U et al (2005) Axillary recurrence rate in breast cancer patients with negative sentinel lymph node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg 241(1):152–158

    PubMed  Google Scholar 

  23. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ (2007) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18(7):1133–1144. doi:10.1093/annonc/mdm271

    Article  PubMed  CAS  Google Scholar 

  24. Guth U, Singer G, Langer I et al (2006) T4 category revision enhances the accuracy and significance of stage III breast cancer. Cancer 106(12):2569–2575. doi:10.1002/cncr.21920

    Article  PubMed  Google Scholar 

  25. Cabioglu N, Hunt KK, Buchholz TA et al (2005) Improving local control with breast-conserving therapy: a 27-year single-institution experience 19. Cancer 104(1):20–29. doi:10.1002/cncr.21121

    Article  PubMed  Google Scholar 

  26. Komoike Y, Akiyama F, Iino Y et al (2006) Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer 106(1):35–41. doi:10.1002/cncr.21551

    Article  PubMed  Google Scholar 

  27. Haffty BG, Reiss M, Beinfield M, Fischer D, Ward B, McKhann C (1996) Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol 14(1):52–57

    PubMed  CAS  Google Scholar 

  28. Nottage MK, Kopciuk KA, Tzontcheva A, Andrulis IL, Bull SB, Blackstein ME (2006) Analysis of incidence and prognostic factors for ipsilateral breast tumour recurrence and its impact on disease-specific survival of women with node-negative breast cancer: a prospective cohort study. Breast Cancer Res 8(4):R44. doi:10.1186/bcr1531

    Article  PubMed  Google Scholar 

  29. Elder EE, Kennedy CW, Gluch L et al (2006) Patterns of breast cancer relapse. Eur J Surg Oncol 32(9):922–927. doi:10.1016/j.ejso.2006.06.001

    Article  PubMed  CAS  Google Scholar 

  30. Fortin A, Larochelle M, Laverdiere J, Lavertu S, Tremblay D (1999) Local failure is responsible for the decrease in survival for patients with breast cancer treated with conservative surgery and postoperative radiotherapy. J Clin Oncol 17(1):101–109

    PubMed  CAS  Google Scholar 

  31. Park CC, Mitsumori M, Nixon A et al (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence 21. J Clin Oncol 18(8):1668–1675

    PubMed  CAS  Google Scholar 

  32. Meric F, Mirza NQ, Vlastos G et al (2003) Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy. Cancer 97(4):926–933. doi:10.1002/cncr.11222

    Article  PubMed  Google Scholar 

  33. Abner AL, Connolly JL, Recht A et al (2000) The relation between the presence and extent of lobular carcinoma in situ and the risk of local recurrence for patients with infiltrating carcinoma of the breast treated with conservative surgery and radiation therapy. Cancer 88(5):1072–1077. doi:10.1002/(SICI)1097-0142(20000301)88:5<1072::AID-CNCR18>3.0.CO;2-D

    Article  PubMed  CAS  Google Scholar 

  34. Jolly S, Kestin LL, Goldstein NS, Vicini FA (2006) The impact of lobular carcinoma in situ in association with invasive breast cancer on the rate of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 66(2):365–371. doi:10.1016/j.ijrobp.2006.05.070

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel Oertli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mechera, R., Viehl, C.T. & Oertli, D. Factors predicting in-breast tumor recurrence after breast-conserving surgery. Breast Cancer Res Treat 116, 171–177 (2009). https://doi.org/10.1007/s10549-008-0187-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-008-0187-y

Keywords

Navigation