title: Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy.
abstract: BACKGROUND
  The current study identified determinants of systemic recurrence and disease-specific survival (DSS) in patients with early-stage breast carcinoma treated with breast-conserving surgery and radiation therapy (breast-conserving therapy, or BCT).
  
  
  METHODS
  The study population consisted of 1,043 consecutive women with Stages I or II breast carcinoma who underwent BCT between 1970 and 1994. Clinical and pathologic characteristics evaluated included age, tumor size, tumor grade, estrogen and progesterone receptor status, surgical margins, axillary lymph node involvement, and use of adjuvant therapy.
  
  
  RESULTS
  At a median follow-up time of 8.4 years, 127 patients (12%) had developed an ipsilateral breast tumor recurrence (IBTR), and 184 patients (18%) had developed a systemic recurrence. On multivariate logistic regression analysis, tumor size greater than 2 cm, positive lymph nodes, lack of adjuvant tamoxifen therapy, and positive margins (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.1-12.3; P = 0.034) were predictors of systemic recurrence. When IBTR was added into the model, adjuvant therapy and surgical margins were not independent predictors; however, IBTR was an independent predictor of systemic recurrence (IBTR vs. no IBTR; OR, 6.2; 95% CI, 3.1-12.3; P < 0.001). The 10 year DSS rate after BCT was 87%. On multivariate Cox proportional hazards model analysis, the following factors were independent predictors of poor DSS: tumor size greater than 2 cm (vs. < or = 2 cm; relative risk [RR], 2.3; 95% CI, 1.2-4.3; P = 0.010), negative progesterone receptor status (vs. positive; RR, 2.7; 95% CI, 1.4-5.1; P = 0.003), positive margins (vs. negative; RR, 3.9; 95% CI, 1.4-11.5; P = 0.011), and IBTR (vs. no IBTR; RR, 5.5; 95% CI, 2.8-11.0; P < 0.001).
  
  
  CONCLUSIONS
  Positive surgical margins and IBTR are predictors of systemic recurrence and disease-specific survival after BCT. Aggressive local therapy is necessary to ensure adequate surgical margins and to minimize IBTR.
authors.affiliation: Department of Surgical Oncology, The University of Texas M D Anderson Cancer Center, Houston, Texas, USA. fmeric@mdanderson.org
authors.forename: Funda
authors.initials: F
authors.lastname: Meric
authors.forename: Nadeem Q
authors.initials: NQ
authors.lastname: Mirza
authors.forename: Georges
authors.initials: G
authors.lastname: Vlastos
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.forename: Marsha D
authors.initials: MD
authors.lastname: McNeese
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local