Spatiotemporal Patterns of Loco-Regional Recurrence After Breast-Conserving Surgery.

Fei-Lin Qu,Jiong Wu,Zhe-Bin Liu,Rui Mao,Jun-Jie Li,Cai-Jin Lin,Gen-Hong Di,A-Yong Cao,Ke-Da Yu,Zhi-Ming Shao,Guang-Yu Liu

doi:10.3389/fonc.2021.690658

Abstract

BackgroundLoco-regional recurrences (LRR) following breast-conserving surgery (BCS) remain a heterogeneous class of disease that has significant variation in its biological behavior and prognosis.MethodsTo delineate the spatiotemporal patterns of LRR after BCS, we analyzed the data of 4325 patients treated with BCS from 2006 to 2016. Clinico-pathological and treatment specific factors were analyzed using the Cox proportional hazards model to identify factors predictive for LRR events. Recurrence patterns were scrutinized based on recurrence type and recurrence-free interval (RFI). Annual recurrence rates (ARR) were compared according to recurrence type and molecular subtype.ResultsWith a median follow-up of 66 months, 120 (2.8%) LRRs were recorded as the first site of failure. Age, pathologic stage, and molecular subtype were identified as predictors of LRR. The major recurrence type was ipsilateral breast tumor recurrence, which mainly (83.6%) occurred ≤5y post surgery. In the overall population, ARR curves showed that relapse peaked in the first 2.5 years. Patients with regional nodal recurrence, shorter RFI, and synchronous distant metastasis were associated with a poorer prognosis. HER2-positive disease had a higher rate of LRR events, more likely to have in-breast recurrence, and had an earlier relapse peak in the first 2 years after surgery.ConclusionsLRR risk following BCS is generally low in Chinese ethnicity. Different recurrence patterns after BCS were related to distinct clinical outcomes. Management of LRR should be largely individualized and tailored to the extent of disease, the molecular profile of the recurrence, and to baseline clinical variables.

Highlights

Breast-conserving surgery (BCS) has been established as the standard of care for early-stage breast cancer (EBC)
Different molecular subtypes are associated with different prognoses, so treatment regimens are typically personalized to the needs of individual patients [6]
We present the potential prognostic value of loco-regional recurrence (LRR) using survival regression model; second, our main objective, the spatiotemporal characteristics of LRR after BCS and the hazard patterns over time according to molecular subtypes

Summary

Introduction

Breast-conserving surgery (BCS) has been established as the standard of care for early-stage breast cancer (EBC). Loco-regional recurrence (LRR) following conservation treatment remains a concern in routine practice, which heralds a poor prognosis and accompanies or precedes distant metastasis in a defined proportion of patients. The risk of LRR in patients with EBC is primarily assessed by baseline factors. Several clinicopathologic risk factors, including young age at onset, lobular histology, high grade, advanced stage at presentation, and specific molecular subtype, have been shown to be predictive for increased rates of local relapse after BCS and whole-breast radiotherapy [4, 5]. There is a clear need to better identify patients who are at increased risk for LRR despite conventional treatment, and for whom a more tailored locoregional approach could improve outcomes. Loco-regional recurrences (LRR) following breast-conserving surgery (BCS) remain a heterogeneous class of disease that has significant variation in its biological behavior and prognosis

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