Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: Long-term results of European Organisation for Research and Treatment of Cancer studies

doi:10.1016/j.ejca.2005.10.006

European Journal of Cancer

Volume 42, Issue 3, February 2006, Pages 351-356

https://doi.org/10.1016/j.ejca.2005.10.006 Get rights and content

Abstract

The aim of this study was to evaluate prognostic factors for isolated loco-regional recurrence in patients treated for invasive stage I or II breast cancer. The study population comprised 3602 women who had undergone primary surgery for early stage breast cancer, who were enrolled in European Organisation for Research and Treatment of Cancer (EORTC) trials 10 801, 10 854, or 10 902, by breast conservation (55%) and mastectomy (45%). The median follow-up time varied from 5.3 (range: 0.6–9.5) to 11.9 years (range: 0.6–17.4). Main outcome was the occurrence of isolated loco-regional recurrence. The results of multivariate analysis showed that younger age and breast conservation were risk factors for isolated loco-regional recurrence (breast cancer under 35 years of age versus over 50 years of age: hazard ratio 2.80 (95% CI 1.41–5.60)); breast cancer age 35–50 years versus over 50 years: hazard ratio 1.72 (95% CI 1.17–2.54); breast conservation (hazard ratio: 1.82 (95% CI 1.17–2.86)). After perioperative chemotherapy, less isolated loco-regional recurrences were observed (hazard ratio 0.63 (95% CI 0.44–0.91)). No significant interaction effects were observed. It is concluded that young age and breast conserving therapy are both independent predictors for isolated loco-regional recurrence. As an isolated loco-regional recurrence is a potentially curable condition, women treated with breast conservation or diagnosed with breast cancer at a young age should be monitored closely to detect local recurrence at an early stage.

Introduction

Loco-regional recurrence of breast cancer is of concern in breast cancer treatment, as it is a well-established independent risk factor for distant metastases and death 1, 2. Many studies have looked for factors associated with the increased risk of loco-regional recurrence [3]. A well-known risk factor is breast conserving surgery, being associated with a higher risk of loco-regional recurrence, compared with mastectomy 4, 5, 6, 7, 8. Risk factors for local recurrence frequently reported in patients treated with breast conserving therapy are: positive margin status, extensive intraductal component and young age of diagnosis of primary tumour 3, 9, 10, 11, 12. Risk factors commonly reported for loco-regional recurrence in patients treated primarily with mastectomy are histological grade, and extensive axillary node involvement 13, 14. We studied risk factors at primary diagnosis of early breast cancer associated with isolated loco-regional recurrence and other recurrences, including distant metastases or death irrespective of primary treatment. We focused on isolated loco-regional recurrences, because these recurrences are not associated with distant metastases and are, in principle, curable, To do this, we re-analysed the data of 3602 patients with early stage breast cancer surgically treated and recruited in three European Organisation for Research and Treatment of Cancer (EORTC) trials (studies 10801, 10854 and 10902). Within all three studies patients were treated with mastectomy or with breast conserving therapy, which allowed us to study prognostic factors in relation to primary treatment.

Section snippets

Selection of trials and patients

Patients were selected from trials that randomised early stage breast cancer patients. EORTC has conducted several large randomised phase III trials concerning the optimal management of breast cancer in patients with stage I or II breast cancer. A total of 4395 breast cancer patients have been enrolled for these trials; EORTC trials 10 801, 10 854 and 10 902. Patients treated with pre-operative chemotherapy (n = 377), those not eligible for the study (due to false inclusion or severe protocol

Results

In all, 55% of the patients underwent breast conserving therapy (Table 1). An isolated loco-regional recurrence without distant metastasis or death within 2 years of follow-up was observed in 172 (4.8%) of the patients (Table 2). Another event (a distant metastasis or death) occurred in 1182 (32.8%) of the patients. A total of 55 (32%) of the isolated loco-regional recurrences were seen in patients treated with mastectomy, and 117 (68%) were seen in patients treated with breast conserving

Discussion

The major risk factor for an isolated loco-regional recurrence in this analysis was younger age as well as breast conservation (breast cancer under 35 years of age: hazard ratio 2.80 (1.41–5.60)); breast cancer between 35 and 50 years of age: hazard ratio 1.72 (1.17–2.54); breast conservation (hazard ratio: 1.82 (1.17–2.86)). No significant interaction effects between these two variables were observed. After perioperative chemotherapy, less isolated loco-regional recurrences were observed

Conflict of interest statement

None declared.

Acknowledgements

The authors thank the European Organisation for Research and Treatment of Cancer (EORTC) for permission to use the data from EORTC trials 10801 (co-ordinator: H. Bartelink), 10854 and 10902 (co-ordinator: C.J.H. van de Velde) for this research.

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¹: Previous address: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.

²: Previous European Organisation for Research and Treatment of Cancer (EORTC) Fellow.

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Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: Long-term results of European Organisation for Research and Treatment of Cancer studies

Abstract

Introduction

Section snippets

Selection of trials and patients

Results

Discussion

Conflict of interest statement

Acknowledgements

Lancet

Ann Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Clin Breast Cancer

Am J Surg

Ann Oncol

Eur J Cancer

Eur J Cancer

Eur J Cancer

Eur J Cancer

Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy?

Cancer

Prognosis after regional lymph node recurrence in patients with stage I–II breast carcinoma treated with breast conservation therapy

Cancer