Impact of primary local treatment on the development of distant metastases or death through locoregional recurrence in young breast cancer patients

Abstract

In this study, we tested the hypothesis whether breast conserving therapy (BCT) compared with mastectomy is associated with a negative outcome in terms of distant metastases or death (DMD) and investigated the relation between locoregional recurrence (LRR) and DMD in young breast cancer (BC) patients. This study included a consecutive series of 536 patients ≤40years of age at diagnosis with pathological T1N0-3M0 BC, treated between 1989 and 2005. A multistate survival model was used to evaluate the influences of local treatment and LRR on DMD, adjusted for potential prognostic factors. Patients were treated with mastectomy (N=213) or BCT (N=323). Median age at diagnosis was 36.3years, with a median follow-up of 9.0years. The 10-year actuarial cumulative incidence of DMD was 30.6% after mastectomy and 26.3% after BCT (P=0.04). In total, 81 (15%) LRRs were observed. After BCT, patients had a threefold higher risk of LRR than after mastectomy (HR 2.9; 95% CI 1.6-5.3). Patients with LRR had a higher risk of DMD compared with patients without LRR (HR 5.5; 95% CI 2.1-14.5). However, BCT was not negatively associated with DMD-after-LRR (HR 0.47; 95% CI 0.2-1.1, BCT vs mastectomy). In conclusion, although LRR significantly affected DMD, the increased risk of LRR after BCT compared with mastectomy did not lead to a worse DMD outcome in BC patients ≤40years of age.