Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer

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Abstract

Between 1983 and 1987, 1309 women with stage I or II breast cancer underwent mastectomy (n=894) or conservative surgery (CS, n=415). Of these patients, 124 developed an isolated local recurrence (ILR): chest wall, 56 and in-breast, 68. The 10-year actuarial rate of cause-specific survival after treatment for ILR was 52%. On multivariate analysis three independent prognostic factors for the risk of death after ILR were identified: operability of recurrence (operable vs. inoperable, relative risk [RR]: 5.9), age at initial diagnosis (>40 vs. ≤40 years, RR: 2.2) and time to ILR (>24 vs. ≤24 months, RR: 2). Initial lymph node stage (negative vs. positive) showed borderline significance (p=0.06), and type of initial surgery (CS vs. mastectomy) and recurrent tumor grade (1-2 vs. 3) were not independent predictors of survival. In the mastectomy group, single surgical scar recurrence with initial node negative stage predicted good prognosis, and the 10-year survival was 85%. In the CS group, the 10-year survival rate was 88% with new primary tumor and 54% with true recurrence (p=0.01), and the type of salvage surgery (mastectomy vs. repeat complete excision) had no significant impact on survival (p=0.2). The majority (n=44) of CS patients developed ≤2 cm in-breast recurrence, and the 10-year survival was 81% after both salvage excision (n=28) and mastectomy (n=16). The identified unfavorable prognostic factors are pointers of the forthcoming systemic progression. Patients with ≤2 cm in-breast recurrence might receive a second CS.

Original languageEnglish
Pages (from-to)302-308
Number of pages7
JournalBreast
Volume17
Issue number3
DOIs
Publication statusPublished - Jun 2008

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Keywords

  • Breast cancer
  • Prognostic factors
  • Survival following local recurrence

ASJC Scopus subject areas

  • Surgery

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