Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow up.
BACKGROUND
Local recurrence remains a major concern after primary treatment of breast cancer and has a major impact on subsequent survival. While most studies report a poorer survival rate in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial whether different risk profiles at the time of primary diagnosis may account for this difference.


METHODS
Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Matching criteria included the primary surgical treatment, tumor size, nodal status, and age. The significance of various prognostic parameters at the time of primary diagnosis and at the time of recurrence were evaluated, by univariate and multivariate analyses, with respect to survival after recurrence. The median follow-up was 8.4 years.


RESULTS
Risk factors at the time of presentation, such as tumor size and lymph node status, were comparable between both groups. Local recurrence occurred on an average 9 months earlier in patients after mastectomy (P = 0.08). Univariate analysis showed that lymph node status (P = 0.0001) and disease-free interval from primary treatment to local recurrence (P = 0.0002) were the most significant single prognostic factors for subsequent survival after local recurrence. The primary surgical treatment modality was shown to be of marginal statistical influence (only P = 0.05).


CONCLUSIONS
Local recurrence after mastectomy seems to be associated with worse survival than after breast-conserving therapy. Early onset of chest-wall recurrence, moreover, represents the highest independent risk for cancer-associated death.
Janni
W
W
Department of Gynecology and Obstetrics, Klinikum Innenstadt, Ludwig-Maximilians-Universität Muenchen, Germany. janni@fk-i.med.uni-muenchen.de
Shabani
N
N
Dimpfl
T
T
Starflinger
I
I
Rjosk
D
D
Peschers
U
U
Bergauer
F
F
Lampe
B
B
Genz
T
T
D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods*; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D015588:Observer Variation; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012878:Skin Neoplasms / Q000556:secondary*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome