title: Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery.
abstract: OBJECTIVE
  To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemotherapy and breast-conserving surgery.
  
  
  METHODS
  Between January 1985 and December 1994, 257 patients with invasive T1 to T3 breast carcinoma were treated with primary chemotherapy, lumpectomy, and radiation therapy. The median follow-up time was 93 months. To evaluate the role of IBTR in metastase-free survival, a Cox regression multivariate analysis was performed using IBTR as a time-dependent covariate.
  
  
  RESULTS
  The IBTR rates were 16% (+/- 2.4%) at 5 years and 21.5% (+/- 3.2%) at 10 years. Multivariate analysis showed that the probability of local control was decreased by the following independent factors: age < or = 40 years, excision margin < or = 2 mm, S-phase fraction more than 4%, and clinical tumor size more than 2 cm at the time of surgery. In patients with excision margins of more than 2 mm, the IBTR rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age < or = 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The contribution of IBTR was highly significant (relative risk = 5.34) when added to the model, whereas age < or = 40 years was no longer significant. After IBTR, 31.4% (+/- 7.0%) of patients developed metastases at 2 years and 59.7% (+/- 8.1%) at 5 years. Skin involvement, size at initial surgery, and estrogen receptor status were predictors of metastases after IBTR.
  
  
  CONCLUSIONS
  IBTR is a strong predictor for distant metastases. There are implications for conservative surgery after downstaging of the tumor and therapy at the time of IBTR.
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
authors.forename: J M
authors.initials: JM
authors.lastname: Extra
authors.forename: M
authors.initials: M
authors.lastname: Carton
authors.forename: M C
authors.initials: MC
authors.lastname: Falcou
authors.forename: A
authors.initials: A
authors.lastname: Vincent-Salomon
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: P
authors.initials: P
authors.lastname: Pouillart
authors.forename: E
authors.initials: E
authors.lastname: Bourstyn
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D011960:Receptors, Estrogen