[Local recurrences after conservative treatment of breast cancer: risk factors and influence on survival].
OBJECTIVE
To determine the risk factors for local and distant failure in node-negative breast cancer treated with breast-conservative surgery and radiotherapy and to determine the relationship between these two events.


METHODS
We retrospectively selected 908 patients who received conservative surgery and radiotherapy but no chemotherapy between 1980 and 1995, for a node-negative breast cancer. Patients were divided in two groups according to the status of the margins of resection. All pathology specimens were reviewed.


RESULTS
In case of negative margins, the risk factors for local recurrences picked up by the Cox model were histologic multifocality (P = 0.0076), peritumoral vessel invasion (P = 0.021) and age < or = 40 years (P = 0.024), and in case of involved margins, negative oestrogen receptors (P = 0.0012), histologic multifocality (P = 0.0028), and absence of hormonal therapy (P = 0.017). The 10-year local recurrence rate was 18% in case of negative margins and 29% in case of involved margins, although in the latter case patients received high-dose adjuvant radiotherapy. Accordingly, the 10-year distant failure rates were 16% and 27%, respectively. Many arguments suggest that local and distant failures are closely related.


CONCLUSIONS
Patients with histologic multifocality or positive margins are at high risk of local failure and then of distant failure, and require a more aggressive initial treatment.
Cowen
D
D
Département de radiothérapie, institut Paoli-Calmettes, Marseille, France.
Houvenaeghel
G
G
Jacquemier
J
J
Resbeut
M
M
Largillier
R
R
Bardou
V J
VJ
Viens
P
P
Maraninchi
D
D
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
Récidives locales après traitement conservateur du cancer du sein: facteurs de risque et influence sur la survie.