title: Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer.
abstract: OBJECTIVE
  To examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma.
  
  
  BACKGROUND
  The efficacy of SSM has been challenged by concerns about increased risks of LR.
  
  
  METHODS
  A consecutive series of 173 patients (176 cancers) with invasive carcinoma underwent SSM and immediate breast reconstruction (June 1986 to December 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model.
  
  
  RESULTS
  Mean patient age was 47 +/- 9 years (27% were 40 or younger). The AJCC stages were 1 = 43%, 2 = 52%, and 3 = 5%. Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, node-positive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death.
  
  
  CONCLUSIONS
  There is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, University of Alabama at Birmingham, USA.
authors.forename: Heriberto
authors.initials: H
authors.lastname: Medina-Franco
authors.forename: Luis O
authors.initials: LO
authors.lastname: Vasconez
authors.forename: R Jobe
authors.initials: RJ
authors.lastname: Fix
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heslin
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Beenken
authors.forename: Kirby I
authors.initials: KI
authors.lastname: Bland
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Urist
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000401:mortality / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome