Abstract
Background:This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy.Methods:1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded.Results:53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p < 0.033). Multivariate analysis showed that younger age (<40 years), large tumor size (>20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p < 0.05).Conclusions:Most of the local recurrences after BCS in our study were true recurrences, which resulted in a poorer outcome as compared to new primary tumors. Moreover, younger age (<40), large tumor size (>2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy strategies should be explored further in young patients with large and high-risk tumors to reduce the risk of TR.
Highlights
As a result of earlier detection of cancer with the wide use of mammographic screening and increased awareness of breast cancer, the number of patients who undergo breast-conserving surgery (BCS) has significantly increased, yielding comparable outcomes to mastectomy [1,2,3,4]
Most of the local recurrences after BCS in our study were true recurrences, which resulted in a poorer outcome as compared to new primary tumors
Local recurrence rates have substantially decreased since modern radiotherapy techniques with boost treatment and new chemotherapeutic agents combined with BCS, substantiating the role of BCS as a valid alternative to mastectomy [3, 5,6,7,8]
Summary
As a result of earlier detection of cancer with the wide use of mammographic screening and increased awareness of breast cancer, the number of patients who undergo breast-conserving surgery (BCS) has significantly increased, yielding comparable outcomes to mastectomy [1,2,3,4]. The incidence of local recurrences that can be classified as true recurrences or new primary tumors is reported to be between 3-5% [10, 15,16]. The histopathology of true recurrences shows features that have similarities to the primary tumor histopathology while being close to the primary tumor bed. True recurrence (TR) rates are reported to be around 62% of ipsilateral breast tumor recurrences (IBTR) [17]. New primary (NP) tumors are classified as IBTR which are localized beyond the primary tumor’s site and have different histopathologic characteristics. This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy
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