title: Prognostic Factors for Distant Metastasis in Patients with Locoregional Recurrence after Mastectomy.
abstract: OBJECTIVE
  The purpose of this study was to identify patients with high risk of distant metastasis (DM) after salvage treatment for postmastectomy locoregional recurrence (LRR).
  
  
  METHODS
  We retrospectively reviewed 142 patients who received salvage radiotherapy with or without wide excision for isolated LRR after mastectomy between January 1999 and December 2012. Distant metastasis-free survival (DMFS) was estimated from the date of diagnosis of isolated LRR to the date of DM or last follow-up using the Kaplan-Meier method, and Cox regression analysis was performed to identify prognostic factors for DM.
  
  
  RESULTS
  The median follow-up period was 54 months. The major failure pattern was DM (56%) and the 5-year DMFS was 43%. In multivariate analysis, initial N (iN) stage, recurrent N (rN) stage, and hormone receptor (HR) status were significant prognostic factors for DM (5-year DMFS: iN0 vs. iN1-3, 73% vs. 25%, p<0.001; rN0 vs. rN1-3, 61% vs. 29%, p<0.001; HR+ vs. HR-, 49% vs. 21%, p<0.001).
  
  
  CONCLUSIONS
  Patients with lymph node involvement and/or HR- specimens seem to experience more DM than patients with chest wall-only recurrence and HR+ specimens. Further studies are needed to investigate the role of chemotherapy in these patients.
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Su Ssan
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gyungyub
authors.initials: G
authors.lastname: Gong
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Son
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Ahn
keywords: Breast neoplasms; Drug therapy; Local neoplasm recurrence; Mastectomy; Neoplasm metastasis