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. 2016 Jan 12;114(1):88-95.
doi: 10.1038/bjc.2015.314. Epub 2015 Dec 10.

Progression of breast cancer following locoregional ipsilateral recurrence: importance of interval time

Jennifer C Melvin  1 , Arnie D Purushotham  2   3 , Hans Garmo  1   4 , Sarah E Pinder  2   3 , Ian S Fentiman  2 , Cheryl Gillett  2 , Anca Mera  1 , Margreet Lüchtenborg  4 , Lars Holmberg  1   4   5 , Mieke Van Hemelrijck  1
Affiliations

Progression of breast cancer following locoregional ipsilateral recurrence: importance of interval time

Jennifer C Melvin et al. Br J Cancer. .

Erratum in

Abstract

Background: Studies comparing prognosis of breast cancer (BC) patients with and without locoregional recurrence (LR) present conflicting results. We aimed to improve our understanding of the impact of LR on prognosis by examining a large cohort of patients treated at Guy's and St Thomas' NHS Foundation Trust.

Methods: Risk factors associated with BC-specific death were investigated using Cox proportional hazards regression in 5199 women diagnosed between 1975 and 2007. Breast cancer-specific death following LR was assessed with Poisson regression.

Results: Overall, 552 women (11%) developed LR, with a median follow-up time of 4.28 years. Known factors associated with BC-specific death (tumour stage, grade, and nodal status) were of significance in our data. Women with a shorter disease-free interval had a worse prognosis. For instance, the HR for BC-specific death among women undergoing mastectomy with an LR 0.5-1 year after diagnosis of their primary tumour was 6.67 (95% CI: 3.71-11.99), when compared with women who did not experience LR.

Conclusions: It often remains difficult to distinguish between a genuine LR and a new primary. The HRs for risk of BC-specific death following a second lesion suggest that they may act as a marker of systemic disease, large tumour burden, or depleted host defence. The clinically highly relevant impairment in prognosis calls for further research into the underlying mechanisms. We showed that for at least 15 years of follow-up, the prognosis in women following the occurrence of an LR may benefit from careful diagnostic and therapeutic management.

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Figures

Figure 1
Figure 1
Estimated hazards of breast cancer death from Poisson regression model. The blue curve represents the hazard of breast cancer death for women without recurrence. The dark red, bright red, dark orange, light orange, yellow, and black curves represent the hazard of breast cancer death for local recurrence diagnosed at different interval times (0.5, 1, 2, 5, 10, and 15 years). There were 5194 women who did not experience a locoregional recurrence (LR) (blue line), 34 women experienced LRs within 6 months, 85 women within 1 year, 108 women between 1 and 2 years, 174 women within 2–5 years, 103 women between 5 and 10 years, and finally, 62 women experienced LRs between 10 and 15 years following their primary diagnosis.
Figure A1
Figure A1
Estimated hazards of breast cancer death from Poisson regression model in (A) women diagnosed between 1975 and 1990 and (B) women diagnosed between 1990 and 2007. The blue curve represents the hazard of breast cancer death for women without recurrence. The dark red, bright red, dark orange, light orange, yellow, and black curves represent the hazard of breast cancer death for local recurrence diagnosed at different interval times (0.5, 1, 2, 5, 10, and 15 years). A full color version of this figure is available at British Journal of Cancer online.
See this image and copyright information in PMC

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