title: The effect of locoregional recurrence on survival and distant metastasis after conservative treatment for invasive breast carcinoma.
abstract: OBJECTIVE
  Patients with invasive breast cancer submitted to conservative treatment must be followed for a long period of time to study locoregional control. In this study, we analysed the outcome and relationships between locoregional recurrence (LRR), distant metastases and survival.
  
  
  METHODS
  A 15-year study, including 470 women with early breast cancer, stage I and II, who underwent breast conservative treatment. Tumour size, nodal status, age, menopausal status, histological grade and LRR were analysed for their ability to predict overall survival, disease-specific survival and distant disease-free survival.
  
  
  RESULTS
  With a median follow-up time of 6.6 years (3 months to 19.1 years), there were 19 LRR at their first site of recurrence and 53 distant metastases. Tumour size greater than 2 cm, positive lymph nodes and histological grade III were significantly related to lower overall and distant metastases-free survival. On multivariate analysis, nodal status, histological grade III and LRR (coded as a time-dependent variable) were significantly related to overall, specific and distant metastases-free survival, whereas tumour size had only a borderline effect on specific and distant disease-free survival. Landmark analysis showed that women who presented an LRR within 2 years after surgery had significantly lower distant disease-free survival (hazard ratio [HR]: 8.39; 95% CI 2.56-27.47; P < 0.001), specific survival (HR: 8.19; 95% CI 2.45-27.41; P < 0.001) and overall survival (HR: 6.02; 95% CI 2.25-16.11; P < 0.005).
  
  
  CONCLUSIONS
  LRR seems to be a significant predictor of distant metastases and survival, and patients who sustain early LRR tend to display a more aggressive clinical course.
authors.affiliation: Radiotherapy Department, Santa Maria University Hospital, Lisbon, Portugal. imonteiro.grillo@hsm.min-saude.pt
authors.forename: I
authors.initials: I
authors.lastname: Monteiro Grillo
authors.forename: M
authors.initials: M
authors.lastname: Jorge
authors.forename: P
authors.initials: P
authors.lastname: Marques Vidal
authors.forename: M
authors.initials: M
authors.lastname: Ortiz
authors.forename: P
authors.initials: P
authors.lastname: Ravasco
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis