Local recurrences in patients with breast cancer at the North Carolina memorial hospital (1970–1982)

Abstract

A study of predictive factors for locoregional recurrences after curative surgery for breast cancer was undertaken. Specifically, the authors wished to determine whether such recurrences correlated with either hormonal receptor status or a delay between the initial biopsy and the definitive surgery. A retrospective chart review was done on all women with breast cancer who had surgery for cure between 1970 and 1982. Factors analyzed included, among others, size of the tumor, clinical and pathologic status of the axilla, estrogen and progesterone receptors status, and delay between biopsy and definitive surgery. There were 404 patients studied. Pathologic axillary nodal status was the most important predictor of locoregional recurrence, with failures in 36 of 188 (19%) node-positive but only 9 of 216 (4%) node-negative patients (P = 0.0001). In node-positive patients, tumor size was a predictor of local recurrence, with failure in only 4 of 51 (8%) of tumors less than 2 cm, but in 14 of 44 (32%) of tumors greater than 6 cm (P = 0.004). Progesterone receptor (PR) status correlated with locoregional recurrence, but estrogen receptor status did not. In node-positive women, there were 4 of 14 PR-negative but 0 of 15 PR-positive local failures (P = 0.017); this result has not been previously reported. The presence of palpable axillary disease was also found to be a predictor of local recurrence. Finally, no increase in locoregional recurrence could be attributed to the delay between biopsy and definitive surgery. Two new predictors for locoregional recurrence in breast cancer, not previously emphasized, are PR and clinical axillary status. Should these findings be substantiated, patients at high risk for locoregional recurrence could then be more readily identified.

Surgery for Breast Cancer

“…402 The frequency of local and regional recurrence for stages I and II breast cancer is clearly related to the stage of the original cancer. 403 The extent of axillary nodal involvement, specifically four or more positive nodes and extranodal extension of tumor, is a significant risk factor for locoregional recurrence. 404 Other biologic characteristics, such as hormone receptor status, 405 high-grade histologic characteristics, 406 and younger age of the patient, 407 as well as the use of adjuvant systemic therapy, are less well defined but may affect the incidence of local recurrence.…”

Prognostic Significance of Local Recurrence in Breast Cancer after Postmastectomy Radiotherapy

“…In these selected patients, we observed a local failure rate of 2.1% despite the fact that patients referred for radiotherapy have probably more often risk factors than patients treated with surgery alone. For patients with locally advanced disease, the local recurrence rate of 6.9% in our series also compares favorably to failure rates of 25% or more that have been reported in these patients with mastectomy alone in a lot of series, although some authors have observed low failure rates comparable to those in our series with additional radiotherapy [2,3,6,7,13,30,31,34,35,38]. In summary, our data are in accordance with radiotherapy results reported in recent studies which showed that radiotherapy prevents seven out of ten local recurrences that would occur without radiation therapy [8,9,24,25,27].…”

Radiotherapy for In Situ, Stage I, and Stage II Breast Cancer

“…268,272,277,[340][341][342][343] The risk for locoregional recurrence also rises with enlarging primary tumor size from less than 10% in patients having tumors larger than 2 cm to 25% to 35% in patients having tumors larger than 5 cm. 268,277,340,344,345,346 The risk for a supraclavicular lymph node recurrence also rises as the number of involved axillary nodes increases and may predict for distant dissemination. 339 The supraclavicular and infraclavicular regions should be included when postmastectomy radiation therapy is delivered.…”