J Breast Cancer.  2015 Dec;18(4):386-393. 10.4048/jbc.2015.18.4.386.

Independent Prognostic Factors for Overall Survival after Salvage Operation for Ipsilateral Breast Tumor Recurrence Following Breast-Conserving Surgery

• Lee JH
• Lee SK
• Park SM
• Ryu JM
• Paik HJ
• Yi HW
• Bae SY
• Lee JE
• Kim SW
• Nam SJ

• KMID: 2176288
• DOI: http://doi.org/10.4048/jbc.2015.18.4.386

Abstract

PURPOSE
Few studies address independent prognostic factors after ipsilateral breast tumor recurrence (IBTR) following breast-conserving surgery (BCS). Locoregional recurrence is associated with distant metastases and increased mortality rates. Therefore anticipating prognoses after IBTR and evaluating risk factors for overall survival following a second salvage operation are important. We evaluated independent prognostic factors affecting overall survival after a second operation for IBTR.
METHODS
We retrospectively identified 11,073 patients who underwent breast cancer surgery between November 1995 and December 2011. Locoregional recurrence occurred in 787 patients. Among them, IBTR developed in 165 patients selected for analysis. Excluding eight patients who refused further treatment, we analyzed 157 patients who underwent a second operation (partial mastectomy, 28 [17.8%]; total mastectomy, 129 [82.2%]) for IBTR. Excluding 26 patients with incomplete data, we evaluated the clinicopathol-ogical features influencing overall survival at the first and the second operation in the 131 patients who underwent a second operation.
RESULTS
The median age of patients at the first operation was 43.6 years (range, 27-69 years). The median duration from the first to the second operation was 45.0 months (range, 2.5-164.6 months). The 5-year overall survival rate after IBTR was 87.1%. In the multivariable analyses, duration from the first to the second operation, histopathology, lymph node status, and adjuvant chemotherapy, radiotherapy, and endocrine therapy at the first operation were independent prognostic factors for overall survival. Positive estrogen receptor status and endocrine therapy at the second operation were also associated with increased overall survival following salvage operations for IBTR.
CONCLUSION
The time interval to IBTR following BCS is related to overall survival after salvage operation for IBTR and it is important to undergo optimal adjuvant treatments according to risk factors after the first operation because those risk factors affect overall survival for IBTR following BCS.

Keyword

Locoregional neoplasm recurrence; Mortality; Prognostic factors; Segmental mastectomy

MeSH Terms

Breast Neoplasms*
Breast*
Chemotherapy, Adjuvant
Estrogens
Humans
Lymph Nodes
Mastectomy
Mastectomy, Segmental*
Mastectomy, Simple
Mortality
Neoplasm Metastasis
Neoplasm Recurrence, Local
Prognosis
Radiotherapy
Recurrence*
Retrospective Studies
Risk Factors
Survival Rate
Estrogens

Figure

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  Figure 1 Consort diagram depicting the study selection process. LRR=locoregional recurrence; BCS=breast-conserving surgery; IBTR=ipsilateral breast tumor recurrence; TM=total mastectomy; PM=partial mastectomy; op=operation.

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  Figure 2 Overall survival after salvage operation for ipsilateral breast tumor recurrence.

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  Figure 3 Overall survival according to second operation methods. TM=total mastectomy; PM=partial mastectomy.

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