title: Outcomes of locoregional recurrence after surgical chest wall resection and reconstruction for breast cancer.
abstract: BACKGROUND
  Locoregional chest wall recurrences involving ribs and/or sternum after primary surgical treatment predict a poor outcome in patients with breast cancer. The precise natural history and surgical outcome of these chest wall recurrences are not fully understood. The objective of this study is to clarify the clinicopathological features of chest wall recurrence of breast cancer and evaluate prognostic factors predicting survival after chest wall resection and reconstruction (CWRR).
  
  
  METHODS
  A total of 28 patients who underwent CWRR at the H. Lee Moffitt Cancer Center between December 1999 and September 2007 were retrospectively analyzed. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables was evaluated by log-rank and Cox regression analyses.
  
  
  RESULTS
  The postoperative morbidity and mortality was 21% and 0%, respectively. Overall 5-year survival for the entire cohort was 18%. Disease-free interval <24 months (P = 0.03) and triple-negative phenotype (P = 0.002) were the only independent predictors of survival. Overall 1-, 2-, and 5-year survival rates for the triple-negative phenotype were 38%, 23%, and 0%, respectively. In contrast, overall 1-, 2-, and 5-year survival rates for the non-triple-negative phenotype were 100%, 70%, and 39%, respectively.
  
  
  CONCLUSIONS
  Radical chest wall resection can be done without mortality and acceptable morbidity to accomplish long-term palliation. The strongest predictor of overall survival was the triple-negative phenotype. Because the triple-negative phenotype is not amenable to any form of therapy, palliative resection may be warranted. Development of appropriate targeted therapies to this population of patients is critical.
authors.affiliation: Department of Surgery at the Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 Magnolia Drive, Suite 3157, Tampa, FL 33612, USA.
authors.forename: Alfredo A
authors.initials: AA
authors.lastname: Santillan
authors.forename: John V
authors.initials: JV
authors.lastname: Kiluk
authors.forename: John M
authors.initials: JM
authors.lastname: Cox
authors.forename: Tammi L
authors.initials: TL
authors.lastname: Meade
authors.forename: Nathon
authors.initials: N
authors.lastname: Allred
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramos
authors.forename: Jeff
authors.initials: J
authors.lastname: King
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cox
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures; D035441:Thoracic Wall / Q000473:pathology*