Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

On behalf of CALOR trial investigators

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated. Methods: In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome. Results: The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 %) of 15 patients with a second ILRR and 19 (51 %) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 % confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 % CI, 0.75–1.00; p = 0.05). Conclusions: Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.

Original languageEnglish
Pages (from-to)398-406
Number of pages9
JournalAnnals of Surgical Oncology
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

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Recurrence
Segmental Mastectomy
Mastectomy
Thoracic Wall
Breast Neoplasms
Drug Therapy
Confidence Intervals
Neoplasm Metastasis
Practice Management
Kaplan-Meier Estimate
Progesterone Receptors
Adjuvant Chemotherapy
Proportional Hazards Models
Hormones

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial. / On behalf of CALOR trial investigators.

In: Annals of Surgical Oncology, Vol. 24, No. 2, 01.02.2017, p. 398-406.

Research output: Contribution to journalArticle

On behalf of CALOR trial investigators. / Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 2. pp. 398-406.
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abstract = "Background: Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated. Methods: In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome. Results: The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 {\%}) of 15 patients with a second ILRR and 19 (51 {\%}) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 {\%} confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 {\%} CI, 0.75–1.00; p = 0.05). Conclusions: Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.",
author = "{On behalf of CALOR trial investigators} and Wapnir, {Irene L.} and Shari Gelber and Anderson, {Stewart J.} and Mamounas, {Eleftherios P.} and Andr{\'e} Robidoux and Miguel Mart{\'i}n and Nortier, {Johan W R} and Geyer, {Charles E.} and Paterson, {Alexander H G} and I. L{\'a}ng and Price, {Karen N.} and Coates, {Alan S.} and Gelber, {Richard D.} and Priya Rastogi and Regan, {Meredith M.} and Norman Wolmark and Stefan Aebi",
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T1 - Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

AU - On behalf of CALOR trial investigators

AU - Wapnir, Irene L.

AU - Gelber, Shari

AU - Anderson, Stewart J.

AU - Mamounas, Eleftherios P.

AU - Robidoux, André

AU - Martín, Miguel

AU - Nortier, Johan W R

AU - Geyer, Charles E.

AU - Paterson, Alexander H G

AU - Láng, I.

AU - Price, Karen N.

AU - Coates, Alan S.

AU - Gelber, Richard D.

AU - Rastogi, Priya

AU - Regan, Meredith M.

AU - Wolmark, Norman

AU - Aebi, Stefan

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N2 - Background: Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated. Methods: In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome. Results: The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 %) of 15 patients with a second ILRR and 19 (51 %) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 % confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 % CI, 0.75–1.00; p = 0.05). Conclusions: Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.

AB - Background: Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated. Methods: In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome. Results: The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 %) of 15 patients with a second ILRR and 19 (51 %) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 % confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 % CI, 0.75–1.00; p = 0.05). Conclusions: Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.

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