Primary Chemotherapy for Operable Breast Cancer: Incidence and Prognostic Significance of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery
| Autor: | Roman Rouzier, Marie-Christine Falcou, Mathieu Carton, Anne Vincent-Salomon, Alain Fourquet, Pierre Pouillart, E. Bourstyn, J.M. Extra |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Time Factors medicine.medical_treatment Breast Neoplasms Mastectomy Segmental Breast cancer medicine Breast-conserving surgery Carcinoma Humans Neoplasm Invasiveness Neoplasm Metastasis Survival analysis Retrospective Studies business.industry Lumpectomy Age Factors Prognosis medicine.disease Combined Modality Therapy Survival Analysis Surgery Radiation therapy Receptors Estrogen Oncology Multivariate Analysis Female Neoplasm Recurrence Local Breast carcinoma business Mastectomy |
| Zdroj: | Journal of Clinical Oncology. 19:3828-3835 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | PURPOSE: To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemotherapy and breast-conserving surgery. PATIENTS AND METHODS: Between January 1985 and December 1994, 257 patients with invasive T1 to T3 breast carcinoma were treated with primary chemotherapy, lumpectomy, and radiation therapy. The median follow-up time was 93 months. To evaluate the role of IBTR in metastase-free survival, a Cox regression multivariate analysis was performed using IBTR as a time-dependent covariate. RESULTS: The IBTR rates were 16% (± 2.4%) at 5 years and 21.5% (± 3.2%) at 10 years. Multivariate analysis showed that the probability of local control was decreased by the following independent factors: age ≤ 40 years, excision margin ≤ 2 mm, S-phase fraction more than 4%, and clinical tumor size more than 2 cm at the time of surgery. In patients with excision margins of more than 2 mm, the IBTR rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age ≤ 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The contribution of IBTR was highly significant (relative risk = 5.34) when added to the model, whereas age ≤ 40 years was no longer significant. After IBTR, 31.4% (± 7.0%) of patients developed metastases at 2 years and 59.7% (± 8.1%) at 5 years. Skin involvement, size at initial surgery, and estrogen receptor status were predictors of metastases after IBTR. CONCLUSION: IBTR is a strong predictor for distant metastases. There are implications for conservative surgery after downstaging of the tumor and therapy at the time of IBTR. |
| Databáze: | OpenAIRE |
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