Prognostic outcome of local recurrence in breast cancer after conserving surgery and mastectomy

Abstract

Background. In our retrospective study we analysed local recurrences in breast cancer patients treated with conserving surgery (CS) followed by adjuvant radiotherapy (RT) or mastectomy (ME) with or without radiotherapy. We analysed the impact of local recurrence on overall survival.

Patients and methods. Between 1980-1995, 306 patients underwent conserving surgery and 1,193 patients were done mastectomy in Masaryk Memorial Cancer Institute. The patients lost to follow-up were excluded. After all, we analysed 236 patients who underwent conserving surgery (Group A), and 1,121 who underwent mastectomy (Group B). All patients with CS received adjuvant RT of the breast with or without regional lymph nodes. In 982 patients (87.6 %) with ME, we performed RT of the chest wall with or without regional lymph nodes. Median age at the time of diagnosis was 48.3 years in Group A and 52.1 years in Group B. In Group A, 149 patients (63.1 %) had T1 tumour, 86 (36.4 %) T2 and 1 (0.5 %) T3. In 24.2 % of patients, axillary node involvement was observed. In Group B, 316 patients (30.4 %) had T1 tumour, 607 (58.3 %) T2, 76 (7.3 %) T3, 33 (3.2 %) T4 and 9 (0.9 %) TX. In 46.2 % of these patients, we found axillary node involvement. Invasive ductal carcinoma was histologically proved in 67.4% in Group A and 84% in Group B. Systemic treatment was given to 133 patients (56.4 %) from Group A and to 857 patients (76.4 %) from Group B.

Results. Median follow-up was 100.5 months in Group A and 121 months in Group B. In Group A, we registered 22 (9.3 %) local recurrences, 5-year local control was 96.2% and median time to local recurrence was 50 months. In Group B, we registered 65 (5.8%) local recurrences; 5-year local control was 96.6%. Fiveyear local control in patients with T1, T2 tumours was 97.2%. In patients with adjuvant RT median time to local recurrence was 48.5 months, and in patients without adjuvant RT 51 months. Thirteen patients (8.7 %) who underwent mastectomy without RT had local recurrence . The impact of local recurrence on overall survival was statistically significant in Group B (p = 0.002) and not exactly statistically significant in Group A (p = 0.062). Patients who developed local recurrence had lover overall survival. Unambiguous linear dependence was confirmed between the time to local recurrence and overall survival.

Conclusions. The impact of local recurrence on overall survival was found statistically significant. Probability of local recurrence and time to local recurrence was the same in the patients treated with CS or ME. The overall survival increased with local disease free interval.