title: Predictors of systemic recurrence and disease-specific survival after ipsilateral breast tumor recurrence.
abstract: BACKGROUND
  In patients with breast carcinoma, ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) is an independent predictor of systemic recurrence and disease-specific survival (DSS). However, only a subgroup of patients with IBTR develop systemic recurrences. Therefore, the management of isolated IBTR remains controversial. The objective of the current study was to identify determinants of systemic recurrence and DSS after IBTR.
  
  
  METHODS
  The medical records of 120 women who underwent BCT for Stage 0-III breast carcinoma between 1971 and 1996 and who subsequently developed isolated IBTR were reviewed. Clinicopathologic factors were studied using univariate and multivariate analyses for their association with DSS and the development of systemic recurrence after IBTR.
  
  
  RESULTS
  The median time to IBTR was 59 months. At a median follow-up of 80 months after IBTR, 45 patients (37.5%) had a systemic recurrence. Initial lymph node status was the strongest predictor of systemic recurrence according to the a univariate analysis (P = 0.001). Other significant factors included lymphovascular invasion (LVI) in the primary tumor, time to IBTR < or = 48 months, clinical and pathologic IBTR tumor size > 1 cm, LVI in the recurrent tumor, and skin involvement at IBTR. In a multivariate logistic regression analysis, initially positive lymph node status (relative risk [RR], 5.3; 95% confidence interval [95% CI], 1.4-20.1; P = 0.015) and skin involvement at IBTR (RR, 15.1; 95% CI, 1.5-153.8; P = 0.022) remained independent predictors of systemic recurrence. The 5-year and 10-year DSS rates after IBTR were 78% and 68%, respectively. In a multivariate Cox proportional hazards model analysis, only LVI in the recurrent tumor was found to be an independent predictor of DSS (RR, 4.6; 95% CI, 1.5-14.1; P = 0.008).
  
  
  CONCLUSIONS
  Patients who initially had lymph node-positive disease or skin involvement or LVI at IBTR represented especially high-risk groups that warranted consideration for aggressive, systemic treatment and novel, targeted therapies after IBTR. Determinants of prognosis after IBTR should be taken into account when evaluating the need for further systemic therapy and designing risk-stratified clinical trials.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Shen
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Nadeem Q
authors.initials: NQ
authors.lastname: Mirza
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
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: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Massimo
authors.initials: M
authors.lastname: Cristofanilli
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000401:mortality; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000401:mortality; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000401:mortality; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging