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Role of Isolated Locoregional Recurrence of Breast Cancer: Results of Four Prospective Studies

From the Institute of Medical Biometry and Medical InformaticsUniversity of Freiburg, Freiburg, and Department of Gynaecology, University of Heidelberg, Heidelberg, Germany.

Address reprint requests to Claudia Schmoor, PhD, Institute of Medical Biometry and Medical Informatics, University of Freiburg, Stefan-Meier-Str 26, D-79104 Freiburg, Germany; email cs{at}imbi uni-freiburg.de.

PURPOSE: We evaluated the effect on future prognosis of an isolated locoregional recurrence (ILRR) after the primary diagnosis of breast cancer. Using data from four prospective studies of the German Breast Cancer Study Group, we investigated factors influencing prognosis after ILRR and defined a simple classification of patients into groups with different prognoses.

PATIENTS AND METHODS: From 1983 to 1989, 2,746 patients were recruited into four studies comparing different treatments in primary breast cancer. After a median follow-up time of 8 years, 337 patients developed an ILRR as the first event. The influence of ILRRs on disease progression was examined. The effects of different prognostic factors on progression-free survival (PFS) and overall survival after ILRR were analyzed after a median follow-up time of 4.5 years.

RESULTS: ILRRs increased the risk with respect to distant recurrence and death. After ILRR, 185 events occurred with respect to the PFS end point, and 171 patients died. Primary nodal status, tumor grade, estrogen receptor status of the primary tumor, and length of the disease-free interval (DFI) until the time of the ILRR had a significant prognostic impact.

CONCLUSION: Determinants of prognosis after the ILRR should be taken into account for designing future risk-adapted clinical studies for these patients. Risk strata can be defined by a simple classification scheme based on primary nodal status and DFI.

Studies were supported by a grant from the Bundesministerium für Forschung und Technologie and long-term follow-up was supported by a grant from the Deutsche Forschungsgemeinschaft, Bonn, Germany.

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