Early versus Late Local Recurrences after Conservative Treatment of Breast Carcinoma: Differences in Primary Tumor Characteristics and Patient Outcome

Abstract

Objectives: To investigate whether some aspects of patient or tumor characteristics influence the timing of local recurrence (LR) in breast cancer treated conservatively, and to assess the impact of the timing of LR on patient outcome. Methods: A retrospective analysis was conducted on patients treated with conservative breast surgery followed by radiotherapy for breast carcinoma who developed LR. Out of 2,008 cases treated in our Institute between 1977 and 2002, 180 ipsilateral LR were observed. Of these, 46 LR were observed within 36 months after treatment, called early local recurrence (ELR), 44 developed between 37 and 60 months, called medium local recurrence (MLR), and 90 occurred after 60 months, called late local recurrence (LLR). Patient and tumor characteristics were analyzed in the 2 groups and compared. Results: Primary tumors >20 mm were more frequently found in patients with ELR (31%) than in patients with LLR (17%, p = 0.047). Grade 3 tumors were more often encountered in patients with ELR than in patients with LLR (27 versus 7%, p = 0.0002). Patients with ELR more frequently had tumors with negative estrogen receptors than patients with LLR (37% versus 6%, p < 0.0001). There was no statistically significant difference in the axillary lymph node (LN) status between patients with ELR and those with LLR (35 and 23% of positive LN, respectively, p = 0.24). Tumor size, grade, LN status, hormone receptors and the timing of LR affected the specific survival (SS) from initial surgery. On multivariate analysis, only LN status and the timing of LR retained an independent prognostic value, with an odds ratio of 6.7 for ELR. After LR, the SS was also influenced by all of the above factors, and on multivariate analysis, LN status, hormone receptors and the timing of LR were independent predictors with an odds ratio of SS of 2.50 in case of ELR (p = 0.006). The 5-year SS after LR for ELR, MLR and LLR were 55.8, 74.8 and 79.5%, respectively. Conclusions: Unfavorable tumor characteristics such as big size, high grade, lack of hormone receptors, but not LN status, were associated with ELR. These findings suggest that patients with such aggressive tumor characteristics who do not recur early will have a lower risk of LLR than patients with more favorable factors.

Local Recurrence after Breast Cancer Affects Specific Survival Differently according to Patient Age

“…There have been numerous studies investigating LR in breast cancer, as a factor negatively affecting patient survival [2,9,11,12,13,14,19,23]. Whether LR is an indicator of an aggressive tumour that has the capacity to seed locally and distally, or is by itself a potential source of distant disease is a matter of debate [2,9,20,24,25,26].…”

“…Most [8,22,23,34,35] but not all [17] investigators have reported that early LR carries a worse prognosis than late LR. In this population, the timing of LR was not significantly different between the 2 age groups, therefore excluding the possibility that the better outcome of younger patients was due to late occurrence of LR.…”

“…It has also been shown that LR negatively affects patient outcome [2,3,8,9,11,12,13,14,15,16,17,18,19,20], especially if LR occurs early [9,11,12,21,22,23]. The question of whether the impact of LR on patient outcome differs according to the patient’s age has not been addressed before.…”

Ductal Carcinoma in situ of the Breast in Israeli Women Treated by Breast-Conserving Surgery Followed by Radiation Therapy

“…At a median follow-up of 10.5 years, the local-relapse-free rate was 85% in the same arm [18, 19]. Primary tumors >20 mm, grade 3, and lack of ER were more frequently found in patients with early local recurrence [20]. Similar results were achieved in the UK DCIS trial [6].…”

“…The DFS survival curves demonstrated DFS of 100% after 5 years, and this value remained 100% at 76 months follow-up. The phenomenon of ipsilateral late relapse of invasive breast cancer is well documented and takes place at least 5 years after the end of the definitive treatment [20]. It may be influenced by several factors such as tumor size, grade, hormone receptor status, and lymph node involvement.…”