Classification of Ipsilateral Breast Tumor Recurrences After Breast Conservation Therapy Can Predict Patient Prognosis and Facilitate Treatment Planning

Yi, Min; Buchholz, Thomas A.; Meric‐Bernstam, Funda; Bedrosian, Isabelle; Hwang, Rosa F.; Ross, Merrick I.; Kuerer, Henry Mark; Luo, Sheng; González-Angulo, Ana M.; Buzdar, Aman U.; Symmans, W. Fraser; Feig, Barry W.; Lucci, Anthony; Huang, Eugene; Hunt, Kelly K.

doi:10.1097/sla.0b013e318208fc2a

Cited by 63 publications

(44 citation statements)

References 39 publications

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“…However, in patients with IBTR, the frequency of node-positive patients was low (2-16%) [22,26,27,30,31] , being comparable to our data (2%). Therefore, the prognostic importance of the tumor size is thought to be more evident in patients with IBTR than in those with primary breast cancer.…”

Section: Discussionsupporting

confidence: 78%

pTis and pT1a Ipsilateral Breast Tumor Recurrence Is Associated with Good Prognosis after Salvage Surgery

Ishitobi

Fukui²,

Hashimoto³

et al. 2017

Oncology

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Objectives: Patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery have a poor prognosis. There is little information regarding the prognostic impact of the tumor size in patients with IBTR. Methods: A total of 143 patients who had histologically confirmed IBTR without distant metastases and who underwent salvage surgery between 1989 and 2013 in our hospital were included. Distant disease-free survival (DDFS) was calculated according to the invasive tumor size of IBTR. The median follow-up period was 4.6 years. Results: Patients with pT1b or more advanced IBTR have a high (≥20%) 5-year distant recurrence risk. There were significant differences in DDFS between patients with pTis or pT1a and those with pT1b or a more advanced stage (5-year DDFS: 94.4 vs. 70.1%, respectively, p value = 0.006). This significance remained after adjusting for other clinicopathological factors (p value = 0.04). Conclusion: Patients with pTis or pT1a IBTR have a good prognosis after salvage surgery for IBTR, and the omission of adjuvant chemotherapy could be considered. Further research and validation studies are needed.

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Section: Discussionsupporting

confidence: 78%

pTis and pT1a Ipsilateral Breast Tumor Recurrence Is Associated with Good Prognosis after Salvage Surgery

Ishitobi

Fukui²,

Hashimoto³

et al. 2017

Oncology

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“…The 9-year mortality rate was 91.3 % for women who had a short interval from DCIS to cancer versus 96.5 % for women for whom the interval was between 6 and 24 years. This is analogous to the prognostic impact of the disease-free interval among patients with an ipsilateral breast tumor recurrence following primary invasive breast cancer [18,19], suggesting that invasive ipsilateral breast cancers following DCIS have characteristics of invasive local recurrences. Our analysis has some limitations.…”

Section: Discussionmentioning

confidence: 68%

Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Sopik

Iqbal

Sun³

et al. 2016

Breast Cancer Res Treat

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A diagnosis of invasive breast cancer after DCIS can be described as a new primary cancer or as a local invasive recurrence. It is of interest to determine if, among women with early-stage breast cancer, a past history of DCIS influences survival. We retrieved the records of 306,249 women diagnosed with stage I or stage II breast cancer between 2004 and 2012, in the surveillance, epidemiology, and end results registries database, of whom 5395 had a previous diagnosis of DCIS. For each patient, we extracted information on the year of diagnosis, age at diagnosis, tumor size, nodal status, grade, estrogen receptor status, type of surgery (lumpectomy/mastectomy), use of radiotherapy (no/yes), prior DCIS (no/yes), cause of death, and follow-up time. For each case with prior DCIS, we recorded information on the year of diagnosis of DCIS, laterality of DCIS, and treatments received for DCIS. We matched 3979 patients with a prior DCIS to 3979 patients without a prior DCIS, according to the various prognostic features of the invasive cancer. We estimated the risk of death from breast cancer for patients with invasive ductal carcinoma, with and without a prior diagnosis of DCIS. We identified 306,249 women with stage I/II breast cancer, of whom 2335 had a prior ipsilateral DCIS and 3060 had a prior contralateral DCIS. Breast cancer-specific survival at 9 years was 94.6 % for patients with a prior DCIS (ipsilateral or contralateral) and was 95.2 % for patients with no prior DCIS (p = 0.32). In a matched analysis (3979 matched pairs), the hazard ratio for death from breast cancer for patients with a prior ipsilateral DCIS, compared to patients with no prior DCIS, was 0.91 (95 % CI = 0.49-1.68; p = 0.75). A prior diagnosis of ipsilateral DCIS does not impact upon the prognosis of women with early-stage invasive breast cancer. This suggests that primary breast cancers and local invasive recurrences following DCIS are similar conditions and should be treated in the same way.

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“…The effect of time since diagnosis on recurrence risk might indicate that we have included a mixture of true recurrences and second primary cancers. In a recent study, Yi et al 17 suggest that approximately one half of inbreast tumour recurrences are true local recurrences of the original cancer; the other half represent new primaries. In that study, the risk of distant metastasis was higher for women categorized as having a true local recurrence than for those categorized as having a second primary.…”

Section: Discussionmentioning

confidence: 99%

“…The effect of radiotherapy was similar, but the effect size was smaller. In the study by Yi et al 17 , prior chemotherapy was a significant adverse prognostic factor among women with local disease recurrence in a univariable analysis (a multivariable analysis was not done). In the calor trial 7 , prior chemotherapy was a nonsignificant predictor of poor survival after local recurrence (odds ratio: 1.97; p = 0.12).…”

Section: Discussionmentioning

confidence: 99%