Factors influencing local recurrence after excision and radiotherapy for primary breast cancer

Locker, A. P.; Ellis, Ian O.; Morgan, D. A. L.; Elston, C.W.; Mitchell, A.; Blamey, R.W.

doi:10.1002/bjs.1800760906

Cited by 150 publications

(46 citation statements)

References 17 publications

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“…It has been supported by many previous studies. [7][8][9][10][11] Jobsen et al reported that age Ͻ 40 years was the only significant predictor of IBTR for women treated with BCT with pathologic T1 tumors and negative lymph node status. 10 Harrold et al showed a correlation with young age and IBTR by using a cutpoint age of 40 years.…”

Section: Discussionmentioning

confidence: 99%

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Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Komoike

Akiyama

Iino

et al. 2005

Cancer

162

103

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BACKGROUNDThe clinical features of ipsilateral breast tumor recurrence (IBTR) after breast conserving therapy (BCT) for early stage breast cancer were analyzed from long‐term follow‐up of BCT in Japan. The purpose of this study was to clarify risk factors of IBTR and the impact of IBTR on development of distant metastases in this ethnic group.METHODSPatients (N = 1901)with unilateral breast cancer ≤ 3 cm in diameter who underwent BCT at 18 Japanese major breast cancer treatment institutes from 1986 to 1993 were registered in this study. Survival rates, the incidences of IBTR and distant metastases, and annual rates of IBTR and distant metastases after primary operation were calculated by the Kaplan–Meier method. A Cox proportional hazards model was used to estimate the risks of IBTR and distant metastases. A Cox model was also used to estimate the risks of distant metastases after IBTR in the group of IBTR.RESULTSAt a median follow‐up time of 107 months, the 10‐year overall and disease‐free survival rates were 83.9% and 77.8%, respectively. The 10‐year cumulative rates of IBTR were 8.5% in the patients with postoperative irradiation and 17.2% in the patients without irradiation. The 10‐year cumulative distant metastasis rate was 10.9%. On multivariate analysis, young age, positive surgical margin, and omission of radiation therapy were significant predictors of IBTR. In addition, IBTR significantly correlated with subsequent distant metastases (hazard ratio, 3.93; 95% confidence interval, 2.676–5.771; P < 0.0001). Among patients who developed IBTR, initial lymph node metastases and short interval to IBTR were significant risk factors for subsequent distant metastasis.CONCLUSIONSYoung age, positive surgical margin, and omission of radiation therapy seemed to be important factors in relation to local control. The authors' results also indicated that IBTR is significantly associated with subsequent distant metastasis. Patients with positive nodal status at primary operation or with short interval from primary operation to IBTR are at especially high risk of distant metastasis. It remains unclear, however, whether IBTR is an indicator or a cause of subsequent distant metastases. Cancer 2006. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

“…For example, young women were generally thought to have a higher frequency of local recurrence. [7][8][9][10][11] Kroman et al recently reported a relation between young age and increasing risk of IBTR, from a study of BCT with over 2000 patients. 12 The European Organization for Research and Treatment of Cancer (EORTC) trial also confirmed the impact of age.…”

mentioning

confidence: 99%

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Komoike

Akiyama

Iino

et al. 2005

Cancer

162

103

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“…The step-wise log-normal model included tumor size and lymph node status which are clinically useful 23 components of pathological staging, along with histological type. Nuclear grade 24,25 and LVPI 26,27 are also recognized as important prognostic factors. Interestingly, this study did not find that over expression of the Her 2 neu oncogene was related to a poorer prognosis, as was found in a previous study of node-negative patients; 28…”

Section: Figmentioning

confidence: 99%

Factors Affecting Distant Disease-Free Survival for Primary Invasive Breast Cancer: Use of a Log-Normal Survival Model

McCready

Chapman²,

Hanna

et al. 2000

Ann Surg Oncol

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Background:Invasive breast cancer is a frequently diagnosed disease that now comes with an ever expanding array of therapeutic management options. We assessed the effects of 20 prognostic factors in a multivariate context. Methods:We accrued clinical data for 156 consecutive patients with stage 1-3 primary invasive breast cancer who were diagnosed in 1989 -1990 at the Henrietta Banting Breast Center, and followed to 1995. There is complete follow-up for 91% of patients (median follow-up of 4.9 years). The event of interest was distant recurrence (for distant disease-free survival, DFS). We used Cox and log-normal step-wise regression to assess the multivariate effects of the following factors on DFS: age, tumor size, nodal status, histology, tumor and nuclear grade, lymphovascular and perineural invasion (LVPI), ductal carcinoma-in-situ (DCIS) type, DCIS extent, DCIS at edge of tumor, ER and PgR, ERICA, adjuvant systemic therapy, ki67, S-phase, DNA index, neu oncogene, and pRb.Results: There was strong evidence against the Cox assumption of proportional hazards for nodal status, and nodal status was not in the Cox step-wise model. With step-wise log-normal regression, a large tumor size (P Ͻ .001), positive nodes (P ϭ .002), high nuclear grade (P ϭ .01), presence of LVPI (P ϭ .03), and infiltrating duct carcinoma not otherwise specified (P ϭ .05) were associated with a reduction in DFS.Conclusions: For nodal status, there was strong evidence against the Cox assumption of proportional hazards, and it was not included in the Cox model although it was in the log-normal model. Only traditional factors were included in the step-wise models. Thus, this statistical management of prognostic markers in breast cancer appears to be very important.

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“…Local recurrence after breast-conserving surgery and radiotherapy is said to occur in around 8% of cases by 5 years (10), although much higher recurrence rates have been reported (23). The majority of surgeons (69%) participating in this study would perform a mastectomy for local recurrence, with only 6% performing a further excision of the recurrence.…”

Section: Discussionmentioning

confidence: 97%

A survey of the management of breast cancer in England and Wales

Harries¹,

Scrivener²,

Kissin³

1994

European Journal of Cancer

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Factors influencing local recurrence after excision and radiotherapy for primary breast cancer

Cited by 150 publications

References 17 publications

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Factors Affecting Distant Disease-Free Survival for Primary Invasive Breast Cancer: Use of a Log-Normal Survival Model

A survey of the management of breast cancer in England and Wales

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