The Influence of Repeat Surgery and Residual Disease on Recurrence After Breast-Conserving Surgery: A Danish Breast Cancer Cooperative Group Study
- 352 Downloads
A significant proportion of women who have breast-conserving surgery (BCS) subsequently undergo re-excision or proceed to mastectomy. This study aimed to identify factors associated with residual disease after repeat surgery and to determine their effect on ipsilateral breast tumor recurrence (IBTR) and survival.
The study cohort was identified within the national population-based registry of the Danish Breast Cancer Cooperative Group, including women who underwent BCS for unilateral invasive breast cancer between 2000 and 2009.
The study investigated 12,656 women. Within 2 months after initial BCS, 1342 (11 %) of these women had a re-excision, and 756 (6 %) of the women had a mastectomy. Residual disease was found in 20 % of re-excisions and 59 % of mastectomies. In adjusted analysis, ductal carcinoma in situ (DCIS) outside the invasive tumor, positive initial margin, and age younger than 50 years were associated with increased risk of residual disease. In the adjusted analysis, patients with residual disease after re-excision had an increased risk of IBTR regardless whether residual findings were invasive carcinoma [hazard ratio (HR), 2.97; 95 % confidence interval (CI) 1.57–5.62] or DCIS (HR, 2.58; 95 % CI 1.50–4.45). However, no difference was seen in overall survival comparing patients receiving one excision with those having repeat surgery with or without residual disease (p = 0.96).
A higher risk of IBTR seen after re-excision was associated with residual disease. Overall survival was similar regardless of repeat surgery and residual findings.
KeywordsResidual Disease Adjuvant Systemic Therapy Ipsilateral Breast Tumor Recurrence Multifocal Tumor Boost Treatment
There are no conflict of interest.
- 16.DBCG Guidelines 2004. Retrieved at http://dbcg.dk/PDF%20Filer/Retningslinier-2004.pdf. Accessed 10 July 2015.
- 21.StataCorp. 2011. Stata Statistical Software: Release 12. StataCorp LP, College Station.Google Scholar
- 34.Bartelink H, Horiot J-C, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–65.PubMedCrossRefGoogle Scholar
- 39.NCCN, Breast Cancer Guidelines, 2015. 2015;41:440.Google Scholar