title: Factors associated with breast cancer mortality after local recurrence.
abstract: OBJECTIVE
  We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery.
  
  
  METHODS
  Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women's College Hospital from 1987 to 1997 and who later developed local recurrence. Clinical information and tumour receptor status were abstracted from medical records and pathology reports. Patients were followed from the date of local recurrence until death or last follow-up. Survival analysis used a Cox proportional hazards model.
  
  
  RESULTS
  Among the 267 women with a local recurrence, 97 (36.3%) died of breast cancer within 10 years (on average 2.6 years after the local recurrence). The actuarial risk of death was 46.1% at 10 years from recurrence. In a multivariable model, predictors of death included short time from diagnosis to recurrence [hazard ratio (hr) for <5 years compared with ≥10 years: 3.40; 95% confidence interval (ci): 1.04 to 11.1; p = 0.04], progesterone receptor positivity (hr: 0.35; 95% ci: 0.23 to 0.54; p < 0.001), lymph node positivity (hr: 2.1; 95% ci: 1.4 to 3.3; p = 0.001), and age at local recurrence (hr for age >45 compared with age ≤45 years: 0.61; 95% ci: 0.38 to 0.95; p = 0.03).
  
  
  CONCLUSIONS
  The risk of death after local recurrence varies widely. Risk factors for death after local recurrence include node positivity, progesterone receptor negativity, young age at recurrence, and short time from diagnosis to recurrence.
authors.affiliation: Department of Medical Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, ON.
authors.forename: R
authors.initials: R
authors.lastname: Dent
authors.affiliation: Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON.
authors.forename: A
authors.initials: A
authors.lastname: Valentini
authors.affiliation: Department of Pathology, Sunnybrook Odette Cancer Centre, Toronto, ON.
authors.forename: W
authors.initials: W
authors.lastname: Hanna
authors.affiliation: Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON.
authors.forename: E
authors.initials: E
authors.lastname: Rawlinson
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON.
authors.forename: E
authors.initials: E
authors.lastname: Rakovitch
authors.affiliation: Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON.
authors.forename: P
authors.initials: P
authors.lastname: Sun
authors.affiliation: Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON.
authors.forename: S A
authors.initials: SA
authors.lastname: Narod
keywords: Breast cancer; mortality; prognostic factors; recurrence