Analysis of local and regional recurrences in breast cancer after conservative surgery.
BACKGROUND
A minority of patients treated conservatively for breast cancer will develop local or regional recurrences. Our aim was to determine how their occurrence may be linked to the evolution of the disease.


METHODS
We analyzed 2784 women treated for early-stage breast cancer by quadrantectomy and whole-breast irradiation in a single institution. We evaluated the prognostic factors associated with local, regional and distant recurrences and the prognostic value of local and regional recurrences on systemic progression.


RESULTS
After a median follow-up of 72 months, we observed 33 local events, 35 regional events and 222 metastases or deaths as first events (5-year cumulative incidence 1.1%, 1.2% and 7.6%, respectively). Size, estrogen receptor status, Her2/Neu and Ki-67 were associated with all three types of events, while axillary status and vascular invasion were associated only with the occurrence of metastases or death. Young age increased the risk of local recurrence. Local and regional recurrences were associated with an increased risk of systemic progression: hazard ratios 2.5 [95% confidence interval (CI) 1.1-5.8] and 5.3 (95% CI 3.0-9.5), respectively.


CONCLUSIONS
Local and regional recurrences after breast-conserving surgery are rare events. They are markers of tumor aggressiveness and indicators of an increased likelihood of distant metastases.
Botteri
E
E
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan. Electronic address: edoardo.botteri@ieo.it.
Bagnardi
V
V
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan; Department of Statistics, University of Milan-Bicocca, Milan.
Rotmensz
N
N
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan.
Gentilini
O
O
Division of Breast Surgery, European Institute of Oncology, Milan.
Disalvatore
D
D
Department of Statistics, University of Milan-Bicocca, Milan.
Bazolli
B
B
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan.
Luini
A
A
Division of Breast Surgery, European Institute of Oncology, Milan.
Veronesi
U
U
Division of Breast Surgery, European Institute of Oncology, Milan; Scientific Directorate, European Institute of Oncology, Milan, Italy.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation / Q000706:statistics & numerical data*; D008875:Middle Aged; D008954:Models, Biological; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D016019:Survival Analysis; D055815:Young Adult