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. 2018 Apr 1;36(10):975-980.
doi: 10.1200/JCO.2017.75.5389. Epub 2018 Jan 31.

Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and III Breast Cancer (AFT-01)

Heather B Neuman  1 , Jessica R Schumacher  1 , Amanda B Francescatti  1 , Taiwo Adesoye  1 , Stephen B Edge  1 , David J Vanness  1 , Menggang Yu  1 , Daniel McKellar  1 , David P Winchester  1 , Caprice C Greenberg  1 ; Alliance/American College of Surgeons Clinical Research Program Cancer Care Delivery Research Breast Cancer Surveillance Working Group
Affiliations

Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and III Breast Cancer (AFT-01)

Heather B Neuman et al. J Clin Oncol. .

Abstract

Purpose National Comprehensive Cancer Network guidelines recommend systemic staging imaging at the time of locoregional breast cancer recurrence. Limited data support this recommendation. We determined the rate of synchronous distant recurrence at the time of locoregional recurrence in high-risk patients and identified clinical factors associated with an increased risk of synchronous metastases. Methods A stage-stratified random sample of 11,046 patients with stage II to III breast cancer in 2006 to 2007 was selected from the National Cancer Database for participation in a Commission on Cancer special study. From medical record abstraction of imaging and recurrence data, we identified patients who experienced locoregional recurrence within 5 years of diagnosis. Synchronous distant metastases (within 30 days of locoregional recurrence) were determined. We used multivariable logistic regression to identify factors associated with synchronous metastases. Results Four percent experienced locoregional recurrence (n = 445). Synchronous distant metastases were identified in 27% (n = 120). Initial presenting stage ( P = .03), locoregional recurrence type ( P = .01), and insurance status ( P = .03) were associated with synchronous distant metastases. The proportion of synchronous metastases was highest for women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence; 54% received systemic staging imaging within 30 days of a locoregional recurrence. Conclusion These findings support current recommendations for systemic imaging in the setting of locoregional recurrence, particularly for patients with lymph node or chest wall recurrences. Because most patients with isolated locoregional recurrence will be recommended locoregional treatment, early identification of distant metastases through routine systemic imaging may spare them treatments unlikely to extend their survival.

Trial registration: ClinicalTrials.gov NCT02171078.

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Figures

Fig 1.
Fig 1.
Overview of locoregional and distant recurrence (DR) on the basis of imaging at time of locoregional recurrence.
Fig 2.
Fig 2.
(A) Proportion of patients with synchronous distant metastases on the basis of type of locoregional recurrence. (B) Proportion of patients with synchronous distance metastases on the basis of initial presenting stage.
Fig 3.
Fig 3.
Overall survival on the basis of type of first recurrence.
Fig A1.
Fig A1.
Time between local recurrence and distant recurrence.
See this image and copyright information in PMC

References

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