title: Prognosis after mastectomy versus repeat lumpectomy in patients with ipsilateral breast cancer recurrence: A propensity score analysis.
abstract: BACKGROUND
  Mastectomy is the current standard surgical procedure for ipsilateral breast tumor recurrence (IBTR). However, there is little evidence about the prognostic impact of the surgical procedure (mastectomy versus repeat lumpectomy) for IBTR.
  
  
  METHODS
  A total of 271 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent definitive surgery for IBTR between 1989 and 2008 were included from eight institutions in Japan. The impact of the surgical procedure for IBTR on distant disease-free survival (DDFS) and overall survival (OS) was evaluated using and multivariable proportional hazards regression and propensity score matching methods.
  
  
  RESULTS
  Of the 271 patients, 149 patients (55%) underwent repeat lumpectomy and 122 patients (45%) underwent mastectomy after IBTR. The median follow-up period from definitive surgery for IBTR was 55 months. There was no difference in terms of DDFS and OS between repeat lumpectomy and mastectomy after IBTR, adjusted for various clinical and tumor characteristics. In addition, for the matched patient cohort, no difference in DDFS and OS was seen between the 2 groups.
  
  
  CONCLUSIONS
  In our study, both multivariate analysis and the propensity score matching method demonstrated that there was no difference in terms of DDFS and OS between repeat lumpectomy and mastectomy after IBTR. Further studies are warranted (UMIN-CTR number UMIN000008136).
authors: Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan.
authors: A
authors: A
authors: Yoshida
authors: Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan.
authors: O
authors: O
authors: Takahashi
authors: Department of Breast & Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors: Y
authors: Y
authors: Okumura
authors: Department of Pathology, Kumamoto City Hospital, Kumamoto, Japan.
authors: N
authors: N
authors: Arima
authors: Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: K
authors: K
authors: Nakatsukasa
authors: Department of Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: M
authors: M
authors: Tanabe
authors: Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
authors: T
authors: T
authors: Shien
authors: Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors: N
authors: N
authors: Masuda
authors: Section of Breast and Endocrine Surgery, Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan.
authors: S
authors: S
authors: Tanaka
authors: Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors: Y
authors: Y
authors: Komoike
authors: Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: T
authors: T
authors: Taguchi
authors: Department of Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: T
authors: T
authors: Iwase
authors: Department of Breast & Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors: R
authors: R
authors: Nishimura
authors: Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors: H
authors: H
authors: Inaji
authors: Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan.
authors: H
authors: H
authors: Yamauchi
authors: Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. Electronic address: isitobi-ma@mc.pref.osaka.jp.
authors: M
authors: M
authors: Ishitobi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Breast cancer; Breast-conserving surgery; Ipsilateral breast tumor recurrence; Mastectomy; Propensity score; Repeat lumpectomy