Prognosis After Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Patients Treated by Breast-Conserving Therapy in Five National Surgical Adjuvant Breast and Bowel Project Protocols of Node-Negative Breast Cancer

被引:345
作者
Anderson, Stewart J. [1 ]
Wapnir, Irene
Dignam, James J.
Fisher, Bernard
Mamounas, Eleftherios P.
Jeong, Jong-Hyeon
Geyer, Charles E., Jr.
Wickerham, D. Lawrence
Costantino, Joseph P.
Wolmark, Norman
机构
[1] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
关键词
RANDOMIZED CLINICAL-TRIAL; COMPARING TOTAL MASTECTOMY; LOCAL RECURRENCE; CONSERVATIVE SURGERY; SEQUENTIAL METHOTREXATE; RADIATION-THERAPY; FOLLOW-UP; CHEMOTHERAPY; TAMOXIFEN; FAILURE;
D O I
10.1200/JCO.2008.19.8424
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Locoregional failure (LRF) after breast-conserving therapy (BCT) is associated with increased risk of distant disease and death. The magnitude of this risk has not been adequately characterized in patients with lymph node-negative disease. Patients and Methods Our study population included 3,799 women randomly assigned to five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative disease (ie, B-13, B-14, B-19, B-20, and B-23) who underwent lumpectomy and whole breast irradiation with or without adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated, along with distant-disease-free interval (DDFI) and overall survival ( OS) after these events. Cox models were employed to model mortality by using clinical and pathologic factors jointly with these events. Results Four hundred nineteen patients (11.0%) experienced LRF: 342 (9.0%) experienced IBTR, and 77 (2.0%) experienced oLRR. The 12-year cumulative incidences of IBTR and oLRR in patients treated with adjuvant systemic therapy were 6.6% and 1.8%, respectively. Overall, 37.1% of IBTRs and 72.7% of oLRRs occurred within 5 years of diagnosis. Older age, black race, higher body mass index (BMI), larger tumors, and occurrence of IBTR or oLRR were significantly associated with increased mortality. The 5-year OS after IBTR and oLRR were 76.6% and 34.9%, respectively. Adjusted hazard ratios for mortality associated with IBTR and oLRR were significantly higher in estrogen receptor (ER)-negative patients than in ER-positive patients (P = .002 and P < .0001, respectively). Patients with early LRF had worse OS and DDFI than those with later-occurring LRF. Conclusion Although LRF is uncommon in patients with node-negative breast cancer who are treated with lumpectomy, radiation, and adjuvant systemic therapy, those who do develop LRF have substantially worse OS and DDFI.
引用
收藏
页码:2466 / 2473
页数:8
相关论文
共 46 条
  • [1] Abe O, 2005, LANCET, V365, P1687, DOI 10.1016/s0140-6736(05)66544-0
  • [2] Adjuvant chemotherapy for lymph node-negative, estrogen receptor-negative breast cancer: A tale of three trials
    Albain, KS
    [J]. JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2004, 96 (24) : 1801 - 1804
  • [3] Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation
    Alpert, TE
    Kuerer, HM
    Arthur, DW
    Lannin, DR
    Haffty, BG
    [J]. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2005, 63 (03): : 845 - 851
  • [4] Local recurrence following breast conservation therapy in African-American women with invasive breast cancer
    Connor, CS
    Touijer, AK
    Krishnan, L
    Mayo, MS
    [J]. AMERICAN JOURNAL OF SURGERY, 2000, 179 (01) : 22 - 26
  • [5] Dignam J J, 2001, J Natl Cancer Inst Monogr, P36
  • [6] Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer
    Dignam, James J.
    Wieand, Kelly
    Johnson, Karen A.
    Raich, Peter
    Anderson, Stewart J.
    Somkin, Carol
    Wickerham, D. Lawrence
    [J]. BREAST CANCER RESEARCH AND TREATMENT, 2006, 97 (03) : 245 - 254
  • [7] Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer
    Dignam, JJ
    Wieand, K
    Johnson, KA
    Fisher, B
    Xu, L
    Mamounas, EP
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2003, 95 (19): : 1467 - 1476
  • [8] High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group study
    Elkhuizen, PHM
    van Slooten, HJ
    Clahsen, PC
    Hermans, J
    van de Velde, CJH
    van den Broek, LCJM
    van de Vijver, MJ
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (05) : 1075 - 1083
  • [9] A RANDOMIZED CLINICAL-TRIAL EVALUATING SEQUENTIAL METHOTREXATE AND FLUOROURACIL IN THE TREATMENT OF PATIENTS WITH NODE-NEGATIVE BREAST-CANCER WHO HAVE ESTROGEN-RECEPTOR-NEGATIVE TUMORS
    FISHER, B
    REDMOND, C
    DIMITROV, NV
    BOWMAN, D
    LEGAULTPOISSON, S
    WICKERHAM, DL
    WOLMARK, N
    FISHER, ER
    MARGOLESE, R
    SUTHERLAND, C
    GLASS, A
    FOSTER, R
    CAPLAN, R
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (08) : 473 - 478
  • [10] SIGNIFICANCE OF IPSILATERAL BREAST-TUMOR RECURRENCE AFTER LUMPECTOMY
    FISHER, B
    ANDERSON, S
    FISHER, ER
    REDMOND, C
    WICKERHAM, DL
    WOLMARK, N
    MAMOUNAS, EP
    DEUTSCH, M
    MARGOLESE, R
    [J]. LANCET, 1991, 338 (8763) : 327 - 331