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Prognostic Factors Affecting Locoregional Recurrence in Patients with Stage IIIB Noninflammatory Breast Cancer

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Abstract

Background

The aim of the present study was to identify the clinicopathological factors affecting locoregional recurrence (LRR) in patients with clinical stage IIIB noninflammatory breast cancer (NIBC).

Methods

The records of 120 stage IIIB NIBC patients treated with neoadjuvant chemotherapy (NAC) and then modified radical mastectomy followed by radiotherapy were evaluated. In this retrospective cohort, the effects of age, menopausal status, clinical tumor size, clinical response to NAC, pathological axillary status, number of positive axillary lymph nodes, pathological response to NAC, grade, lymphovascular invasion, estrogen receptor status, progesterone receptor status, Her-2-neu status, and p53 status on LRR were evaluated by univariate and multivariate analyses.

Results

The clinical response rate of 120 patients was 79.2% (17.5% complete and 61.7% partial), with a complete pathological response rate of 12.5%. The median follow-up was 28 months (range: 10–74 months). The LRR rate was 13.3%. Based on the univariate analysis, the clinical tumor size, clinical response rate, pathological axillary status, four or more positive axillary lymph nodes, lymphovascular invasion, and estrogen receptor status were factors that significantly affected LRR. In the multivariate analysis, however, only the clinical response rate and the number of positive axillary lymph nodes were found to be statistically significant independent factors.

Conclusions

Effective local control of disease can be achieved in patients with stage IIIB NIBC using a combination of NAC, surgery, and radiotherapy. However, a worse clinical response after chemotherapy and four or more positive axillary lymph nodes affect LRR negatively in these patients.

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References

  1. Heys SD, Eremin JM, Sarkar TK, et al. (1994) Role of multimodality therapy in the management of locally advanced carcinoma of the breast. J Am Coll Surg 179:493–504

    PubMed  CAS  Google Scholar 

  2. Wolff AC, Davidson NE (2002) Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease. Oncologist 7:239–245

    Article  PubMed  Google Scholar 

  3. Low JA, Berman AW, Steinberg SM, et al. (2004) Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy. J Clin Oncol 22:4067–4074

    Article  PubMed  CAS  Google Scholar 

  4. Hunt KK, Ames FC, Singletary SE, et al. (1996) Locally advanced noninflammatory breast cancer. Surg Clin North Am 76:393–410

    Article  PubMed  CAS  Google Scholar 

  5. Bonadonna G, Veronesi U, Brambilla C, et al. (1990) Primary chemotherapy to avoid mastectomy in tumours with diameters of three centimeters or more. J Natl Cancer Inst 82:1539–1545

    Article  PubMed  CAS  Google Scholar 

  6. Hortobagyi GN, Buzdar AU, Strom EA, et al. (1995) Primary chemotherapy for early and advanced breast cancer. Cancer Lett 90:103–109

    Article  PubMed  CAS  Google Scholar 

  7. Buzdar AU, Singletary SE, Booser DJ, et al. (1995) Combined modality treatment of stage III and inflammatory breast cancer. Surg Oncol Clin North Am 4:715–734

    CAS  Google Scholar 

  8. Wallgren A, Bonetti M, Gelber RD, et al. (2003) Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group trials I through VII. J Clin Oncol 21:1205–1213

    Article  PubMed  CAS  Google Scholar 

  9. Voogd AC, Nielsen M, Peterse JL, et al. (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 19:1688–1697

    PubMed  CAS  Google Scholar 

  10. Woodward WA, Strom EA, Tucker SL, et al. (2003) Locoregional recurrence after doxorubicin-based chemotherapy and postmastectomy: implications for breast cancer patients with early-stage disease and predictors for recurrence after postmastectomy radiation. Int J Radiat Oncol Biol Phys 57:336–344

    Article  PubMed  CAS  Google Scholar 

  11. Aktepe F, Kapucuoğlu N, Pak I (1996) The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer. Histopathology 29:63–67

    Article  PubMed  CAS  Google Scholar 

  12. Greene FL, Page DL, Fleming ID, et al. (2002) AJCC Cancer Staging Manual, 6th Edition, New York, Springer-Verlag, 227–228

    Google Scholar 

  13. Frierson HF, Walber RA, Berean KW, et al. (1995) Interobserver reproducibility of the Notthingam Modification of the Bloom and Richardson histologic grading scheme for infiltrating ductal carcinoma. Am J Clin Pathol 103:195–198

    PubMed  Google Scholar 

  14. Eltahir A, Heys SD, Hutcheon AW, et al. (1998) Treatment of large and locally advanced breast cancers using neoadjuvant chemotherapy. Am J Surg 175:127–132

    Article  PubMed  CAS  Google Scholar 

  15. Sataloff DM, Mason BA, Prestipino AJ, et al. (1995) Pathologic response to induction chemotherapy in locally advanced carcinoma of the breast: a determinant of outcome. J Am Coll Surg 180:297–306

    PubMed  CAS  Google Scholar 

  16. Bergh J, Jonsson PE, Glimelius B, et al. (2001) A systematic overview of chemotherapy effects in breast cancer. Acta Oncol 40:253–281

    Article  PubMed  CAS  Google Scholar 

  17. Yıldırım E, Semerci E, Berberoğlu U (2000) The analysis of prognostic factors in stage III-B non-inflammatory breast cancer. Eur J Surg Oncol 26:34–38

    Article  PubMed  Google Scholar 

  18. Swain SM (1990) Selection therapy for sage III breast cancer. Surg Clin North Am 70:1061–1080

    PubMed  CAS  Google Scholar 

  19. Hutcheon AW, Heys SD, Miller ID, et al. (2001) Improvements in survival in patients receiving primary chemotherapy with docetaxel for breast cancer: a randomized controlled trial. Breast Cancer Res Treat 69:298

    Google Scholar 

  20. Grohn P, Heinonen E, Klefstrom P, et al. (1984) Adjuvant postoperative radiotherapy, chemotherapy and immunotherapy in stage III breast cancer. Cancer 54:670–674

    Article  PubMed  CAS  Google Scholar 

  21. Hortobagyi GN, Ames FC, Buzdar AK, et al. (1988) Management of stage III primary breast cancer with primary chemotherapy, surgery and radiation therapy. Cancer 62:2507–2516

    Article  PubMed  CAS  Google Scholar 

  22. Schwartz G, Birchansky C, Komarnicky L, et al. (1994) Induction chemotherapy followed by breast conservation for locally advanced carcinoma of breast. Cancer 73:362–369

    Article  PubMed  CAS  Google Scholar 

  23. Fisher B, Bryant J, Wolmark N, et al. (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685

    PubMed  CAS  Google Scholar 

  24. Braud AC, Asselain B, Scholl S, et al. (1999) Neoadjuvant chemotherapy in young breast cancer patients: correlation between response and relapse? Eur J Cancer 35:392–397

    Article  PubMed  CAS  Google Scholar 

  25. Brain E, Garrino C, Misset JL, et al. (1997) Long term prognostic and predictive factors in 107 stage II/III breast cancer patients treated with anthracycline-based neoadjuvant chemotherapy. Br J Cancer 75:1360–1367

    PubMed  CAS  Google Scholar 

  26. Fisher B, Brown A, Mamounas E, et al. (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493

    PubMed  CAS  Google Scholar 

  27. Bear HD, Anderson S, Brown A, et al. (2003) The effect on tumor response of adding preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21:4165–4174

    Article  PubMed  CAS  Google Scholar 

  28. Jatoi I, Michael AP (2005) Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer. A pooled analysis of updated results. Am J Clin Oncol 28:289–294

    Google Scholar 

  29. Jacquillat C, Weil M, Baillet F, et al. (1990) Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer 66:119–129

    Article  PubMed  CAS  Google Scholar 

  30. Buchholz TA, Tucker SL, Masullo L, et al. (2002) Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation. J Clin Oncol 20:17–23

    Article  PubMed  CAS  Google Scholar 

  31. Rustogi A, Budrukkar A, Dinshaw K, et al. (2005) Management of locally advanced breast cancer: Evolution and current practice. J Cancer Res Ther 1:21–30

    Article  PubMed  Google Scholar 

  32. Fisher B, Anderson S, Fisher ER, et al. (1991) Significance of ipsilateral breast tumor recurrence after lumpectomy. Lancet 338:327–331

    Article  PubMed  CAS  Google Scholar 

  33. Veronesi U, Marubini E, Del Vecchio M, et al. (1995) Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 87:19–27

    Article  PubMed  CAS  Google Scholar 

  34. McIntosh SA, Ogston KN, Payne S, et al. (2003) Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy. Am J Surg 185:525–531

    Article  PubMed  Google Scholar 

  35. Huang EH, Tucker SL, Strom EA, et al. (2005) Predictors of locoregional recurrence in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiotherapy. Int J Radiat Oncol Biol Phys 62:351–357

    Article  PubMed  Google Scholar 

  36. Commiskey RD, Mera R, Levince EA (1998) Preoperative chemotherapy for locally advanced breast carcinoma at Charity Hospital, New Orleans, Lousiana. Am Surg 64:103–106

    Google Scholar 

  37. Fentiman IS, Lavelle MA, Caplan D, et al. (1986) The significance of supraclavicular fossa node recurrence after radical mastectomy. Cancer 57:908–910

    Article  PubMed  CAS  Google Scholar 

  38. Rubens RD, Bartelink H, Engelsman E, et al. (1989) Locally advanced breast cancer: the contribution of cytotoxic and endocrine treatment to radiotherapy. Eur J Cancer Clin Oncol 25:667–678

    Article  PubMed  CAS  Google Scholar 

  39. Swain SM, Sorace RA, Bagley CS, et al. (1987) Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. Cancer Res 47:3889–3894

    PubMed  CAS  Google Scholar 

  40. Loprinzi C, Carbone P, Tormey D, et al. (1984) Aggressive combined modality therapy for advanced local-regional breast carcinoma. J Clin Oncol 2:157–163

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Ankara Oncology Training and Research Hospital, Urankent sitesi, C-9 block, No:33, 06200, Demetevler, 06200, Ankara, Turkey

    Kaptan Gülben, Uğur Berberoğlu, Aziz Cengiz & Hüseyin Altınyollar

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  1. Kaptan Gülben
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  2. Uğur Berberoğlu
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  3. Aziz Cengiz
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  4. Hüseyin Altınyollar
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Correspondence to Kaptan Gülben.

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Gülben, K., Berberoğlu, U., Cengiz, A. et al. Prognostic Factors Affecting Locoregional Recurrence in Patients with Stage IIIB Noninflammatory Breast Cancer. World J Surg 31, 1724–1730 (2007). https://doi.org/10.1007/s00268-007-9139-7

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  • DOI: https://doi.org/10.1007/s00268-007-9139-7

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