title: Risk Factors Associated with Distant Metastasis and Survival Outcomes in Breast Cancer Patients with Locoregional Recurrence.
abstract: OBJECTIVE
  To decide the optimal treatment for breast cancer patients with locoregional recurrence (LRR), it is important to determine which group has the highest risk of subsequent distant metastasis (DM). We aimed to investigate the factors associated with DM in patients with LRR.
  
  
  METHODS
  We reviewed the data of 208 patients with LRR as the first event after primary surgery for breast cancer at our institution between 1997 and 2010, to identify significant factors associated with DM. Subsequently, Kaplan-Meier curves and the Cox regression method were used to analyze the correlation between clinical factors and survival.
  
  
  RESULTS
  DM occurred in 33.2% (68/208) of LRR patients. The median DM-free interval was 23 months. Some clinical factors were associated with DM in univariate analysis, including the type of primary surgery (p=0.026), tumor size (p=0.005), nodal status (p=0.011), and administration of initial adjuvant chemotherapy (p=0.001). In addition, regional rather than local recurrence and a disease-free interval (DFI; duration between primary surgery and LRR) ≤30 months were also significant (p<0.001 for both). However, only a shorter DFI reached significance in multiple logistic regression analysis. Cox regression analysis of DM-free survival showed that both a shorter DFI and regional recurrence were significant factors with hazard ratios of 2.1 (95% confidence interval [CI], 1.21-3.65) and 1.85 (95% CI, 1.04-3.28), respectively.
  
  
  CONCLUSIONS
  DFI was the most important factor associated with subsequent DM in patients with LRR as a first event of failure.
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Soojin
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Wonshik
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Surgery, Boramae Medical Center, Seoul, Korea.
authors.forename: Jongjin
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Kangwon National University Hospital, Chuncheon, Korea.
authors.forename: Min Kyoon
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Bundang Jesaeng Hospital, Seongnam, Korea.
authors.forename: Eunshin
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Tae-Kyung
authors.initials: TK
authors.lastname: Yoo
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Han-Byoel
authors.initials: HB
authors.lastname: Lee
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Kang
authors.affiliation: Department of Surgery, Breast Cancer Center, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Yun-Gyoung
authors.initials: YG
authors.lastname: Kim
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyeong-Gon
authors.initials: HG
authors.lastname: Moon
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Noh
keywords: Breast neoplasms; Local neoplasm recurrence; Neoplasm metastasis; Prognosis; Risk factors