title: True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer.
abstract: BACKGROUND
  This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy.
  
  
  METHODS
  1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded.
  
  
  RESULTS
  53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p < 0.033). Multivariate analysis showed that younger age (<40 years), large tumor size (>20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p < 0.05).
  
  
  CONCLUSIONS
  Most of the local recurrences after BCS in our study were true recurrences, which resulted in a poorer outcome as compared to new primary tumors. Moreover, younger age (<40), large tumor size (>2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy strategies should be explored further in young patients with large and high-risk tumors to reduce the risk of TR.
authors.affiliation: General Surgery, Istanbul Florence Nightingale Hospital.
authors.forename: Dauren
authors.initials: D
authors.lastname: Sarsenov
authors.affiliation: General Surgery, Istanbul Florence Nightingale Hospital.
authors.forename: Serkan
authors.initials: S
authors.lastname: Ilgun
authors.affiliation: Medical Oncology, Gayrettepe Florence Nightingale Hospital.
authors.forename: Cetin
authors.initials: C
authors.lastname: Ordu
authors.affiliation: Radiation Oncology, Gayrettepe Florence Nightingale Hospital.
authors.forename: Gul
authors.initials: G
authors.lastname: Alco
authors.affiliation: Statistics, Istanbul Florence Nightingale Hospital.
authors.forename: Atilla
authors.initials: A
authors.lastname: Bozdogan
authors.affiliation: Radiology, Gayrettepe Florence Nightingale Hospital.
authors.forename: Filiz
authors.initials: F
authors.lastname: Elbuken
authors.affiliation: Medical Oncology, Istanbul Bilim University.
authors.forename: Kezban
authors.initials: K
authors.lastname: Nur Pilanci
authors.affiliation: Radiology, Istanbul Florence Nightingale Hospital.
authors.forename: Filiz
authors.initials: F
authors.lastname: Agacayak
authors.affiliation: Physical Therapy and Rehabilitation, Istanbul Bilim University.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Erdogan
authors.affiliation: Medical Oncology, Istanbul University.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Eralp
authors.affiliation: Radiation Oncology, Gayrettepe Florence Nightingale Hospital.
authors.forename: Maktav
authors.initials: M
authors.lastname: Dincer
authors.affiliation: Department of Surgery, Istanbul University.
authors.forename: Vahit
authors.initials: V
authors.lastname: Ozmen
keywords: breast cancer; breast conserving surgery; ipsilateral breast tumor recurrence