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Observational Study
. 2017 Jul;266(1):165-172.
doi: 10.1097/SLA.0000000000001930.

Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer: The POSH Observational Cohort Study

Tom Maishman  1 , Ramsey I Cutress, Aurea Hernandez, Sue Gerty, Ellen R Copson, Lorraine Durcan, Diana M Eccles
Affiliations
Observational Study

Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer: The POSH Observational Cohort Study

Tom Maishman et al. Ann Surg. 2017 Jul.

Abstract

Objective: To assess clinical and surgical factors affecting local recurrence and survival in young breast cancer patients in the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH).

Background: Emerging data suggest young age is a predictor of increased local recurrence.

Methods: POSH is a prospective cohort of 3024 women of 18 to 40 years with breast cancer. Cohort characteristics were grouped by mastectomy or BCS. Endpoints were local-recurrence interval (LRI), distant disease-free interval (DDFI), and overall survival (OS); described using cumulative-hazard and Kaplan-Meier plots and multivariable analyses by Flexible Parametric and Cox regression models.

Results: Mastectomy was performed in 1464 patients and breast-conserving surgery (BCS) in 1395. Patients undergoing mastectomy had larger tumors and higher proportions of positive family history, estrogen receptor+, progesterone receptor+, and/or human epidermal growth factor receptor 2+ tumors. Local events accounted for 15% of recurrences. LRI by surgical type varied over time with LRI similar at 18 months (1.0% vs 1.0%, P = 0.348) but higher for BCS at 5 and 10 years (5.3% vs 2.6%, P < 0.001; and 11.7% vs 4.9%, P < 0.001, respectively). Similar results were found in the adjusted model. Conversely, distant-metastases and deaths were lower for BCS but not after adjusting for prognostic factors. After mastectomy chest-wall radiotherapy was associated with improved LRI (hazard ratio, HR = 0.46, P = 0.015). Positive surgical margins, and development of local recurrence predicted for reduced DDFI (HR = 0.50, P < 0.001; and HR = 0.29, P = 0.001, respectively).

Conclusions: Surgical extent appears less important for DDFI than completeness of excision or, where appropriate, chest-wall radiotherapy. Despite higher local-recurrence rates for BCS, surgical type does not influence DDFI or OS after adjusting for known prognostic factors in young breast cancer patients.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart for POSH study; local-recurrence analyses.
FIGURE 2
FIGURE 2
Local-recurrence interval for all patients by surgical type. A, Nelson-Aalen cumulative hazard plot. B, Flexible parametric survival model time-varying hazard over time.
FIGURE 3
FIGURE 3
Distant disease free interval Kaplan-Meier plot for all patients by surgical type.
FIGURE 4
FIGURE 4
Overall survival Kaplan-Meier plot for all patients by surgical type.
See this image and copyright information in PMC

References

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