Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma.
BACKGROUND
The authors analyzed the outcome of patients with early-stage breast carcinoma after an isolated local recurrence, taking into account initial tumor characteristics and the type of initial treatment and local salvage treatment.


METHODS
One hundred five patients were studied who presented with a breast tumor measuring <or= 25 mm and who subsequently developed an isolated local recurrence (breast or chest wall) as the first tumor event. A second series included 335 patients who developed distant metastases as the first event. Cox models that took into account potential prognostic factors were used to estimate the risk of death. First, survival rates were compared after an isolated local recurrence and after a diagnosis of distant metastases; and, second, effects of initial treatments and local or systemic treatments of local recurrences were analyzed.


RESULTS
The 10-year survival rate was 56% (95% confidence interval, 45-65%) after an isolated local recurrence compared with 9% (95% confidence interval, 7-13%) after distant metastasis as the first event. Three independent prognostic factors for the risk of death after local recurrence were identified: histologic tumor grade, patient age at the time of diagnosis with the primary tumor, and disease free interval until recurrence. The type of initial treatment and local salvage treatment did not influence the risk of death. Systemic treatments of local recurrence had different effects according to the patient's menopausal status. In premenopausal patients, ovarian suppression and chemotherapy significantly decreased the risk of death. In postmenopausal women, systemic treatments did not affect the risk of death.


CONCLUSIONS
Isolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis. The outcome of patients is not affected by the type of initial treatment or local salvage treatment. After a local recurrence, ovarian suppression or chemotherapy had a beneficial effect in premenopausal patients.
Lê
Monique G
MG
INSERM Unit 521, Institut Gustave-Roussy, Villejuif, France. lemon@igr.fr
Arriagada
Rodrigo
R
Spielmann
Marc
M
Guinebretière
Jean-Marc
JM
Rochard
France
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome