title: Clinicopathologic factors of the recurrent tumor predict outcome in patients with ipsilateral breast tumor recurrence.
abstract: BACKGROUND
  The role of clinicopathologic characteristics of the recurrent tumor in determining survival in a cohort of patients with ipsilateral breast tumor recurrence (IBTR) was investigated.
  
  
  METHODS
  Among 6020 women with pT1-T2, pN0-1, M0 treated with breast-conserving surgery from 1989 to 1999, 269 developed isolated IBTR. Ten-year Kaplan-Meier breast cancer-specific survival (BCSS) and overall survival (OS), calculated from date of IBTR, were analyzed according to clinicopathologic characteristics.
  
  
  RESULTS
  Factors that were associated with diminished OS and BCSS on univariate analysis were: time to IBTR ≤48 months, lymphovascular invasion positive status, estrogen receptor (ER) negative status, high grade, clinical IBTR detection, biopsy alone, and close/positive margins (all P < .05). On multivariate analysis, time to IBTR ≤48 months (hazard ratio [HR], 1.87, P = .012), lymphovascular invasion positive status (HR, 2.46; P < .001), ER negative status (HR, 2.08; P = .013), high-grade recurrent disease (HR, 1.88; P = .013), and close/positive margins after surgery for IBTR (HR, 1.94; P = .013) retained significance for prediction of diminished OS. When stratified according to number of adverse prognostic features, 10-year OS was 70.4% in patients with 1 factor, 35.8% with 2 factors, and 19.9% with 3 or more factors (P < .001).
  
  
  CONCLUSIONS
  Time to recurrence ≤48 months, lymphovascular invasion positive status, ER negative status, high-grade histology, and close/positive margins in association with the recurrent tumor are independent prognostic factors for survival after IBTR. The presence of 2 or more of these features at recurrence is significantly associated with poor OS. These criteria can be used to prognosticate and guide clinical decisions after recurrence.
authors.affiliation: Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada. vpanetraymond@gmail.com
authors.forename: Valerie
authors.initials: V
authors.lastname: Panet-Raymond
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Cheryl
authors.initials: C
authors.lastname: Alexander
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Rachel E
authors.initials: RE
authors.lastname: McDonald
authors.forename: Peter H
authors.initials: PH
authors.lastname: Watson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D012306:Risk