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Primary Chemotherapy for Operable Breast Cancer: Incidence and Prognostic Significance of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery

From the Departments of Surgery, Biostatistics, Oncology, Radiotherapy, and Pathology, Institut Curie, Paris, France.

Address reprint requests to Edwige Bourstyn, MD, Department of Surgery, 26 rue d’Ulm, 75005 Paris, France; email: edwige.bourstyn{at}curie.net

PURPOSE: To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemotherapy and breast-conserving surgery.

PATIENTS AND METHODS: Between January 1985 and December 1994, 257 patients with invasive T1 to T3 breast carcinoma were treated with primary chemotherapy, lumpectomy, and radiation therapy. The median follow-up time was 93 months. To evaluate the role of IBTR in metastase-free survival, a Cox regression multivariate analysis was performed using IBTR as a time-dependent covariate.

RESULTS: The IBTR rates were 16% (± 2.4%) at 5 years and 21.5% (± 3.2%) at 10 years. Multivariate analysis showed that the probability of local control was decreased by the following independent factors: age 40 years, excision margin 2 mm, S-phase fraction more than 4%, and clinical tumor size more than 2 cm at the time of surgery. In patients with excision margins of more than 2 mm, the IBTR rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The contribution of IBTR was highly significant (relative risk = 5.34) when added to the model, whereas age 40 years was no longer significant. After IBTR, 31.4% (± 7.0%) of patients developed metastases at 2 years and 59.7% (± 8.1%) at 5 years. Skin involvement, size at initial surgery, and estrogen receptor status were predictors of metastases after IBTR.

CONCLUSION: IBTR is a strong predictor for distant metastases. There are implications for conservative surgery after downstaging of the tumor and therapy at the time of IBTR.

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