Preview

Sechenov Medical Journal

Advanced search

Local-free recurrence survival after breast-conserving surgery and the breast cancer complex treatment

https://doi.org/10.47093/2218-7332.2021.12.1.30-38

Abstract

Aim. To determine the frequency of local recurrence of breast cancer (BC) after performing breast-conserving surgery (BCS) during and after complex treatment, to study the risk factors for local recurrence and survival.

Materials and methods. A retrospective cohort study of 675 patients with breast cancer who underwent BCS followed by remote radiotherapy was conducted. The frequency of local relapse and risk factors were studied, 3- and 5-year local-free survival. The odds ratios (OR) and 95% confidence intervals (CI) were calculated, and the Kaplan–Meyer curves were constructed.

Results. Radical breast resections (RBR) were performed in 46.7% of patients, and oncoplastic breast resections (OBS) in 53.3% of patients. The most common histological type in both groups was invasive cancer with no signs of specificity: 76.9% and 84.1% – in the OBS and RBR groups, respectively. The incidence of cancer in situ was higher in the OBS group: 14.7% vs. 3.3% in the RBR group (p < 0.001), metastases in regional lymph nodes were more frequent in the RBR group: 34.3% against 20.3% in OBS (p < 0.001). According to the immunohistochemical type and degree of differentiation, the groups did not differ. For 3 years, the relapse-free survival rate was 99.7% in both groups, and for 5 years – 99.2% in the OBS group. and 99.7% in the RBR group, 6 years – 98.3% and 98.7%, respectively; no significant differences were found between the groups. There were no statistically significant differences in the frequency of relapses depending on the width of the resection edges from <1 to ≥10 mm. The risk of relapse was increased with a preserved menstrual status (OR 20.05; 95% CI 2.52–159.33), Her2/neu–positive (OR 5.11; 95% CI 1.04–25.09) and triple-negative types (OR 4.02; 95% CI 1.02–15.95), the degree of differentiation of G3 (OR 5.58; 95% CI 1.59–19.64).

Conclusion. BCS is characterized by oncological safety; the rate of local relapse within 6 years is 1.5%. Risk factors for relapse include active menstrual status, highly aggressive immunohistochemical types of breast cancer, and low degree of differentiation.

About the Authors

A. D. Zikiryahodjaev
P.A. Herzen Moscow Research Institute of Oncology – branch of the FSBI “NMITs radiology” of the Ministry of Health of Russia; Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Azizzhon D. Zikiryahodjaev, Dr of Sci. (Medicine), Head of the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin

6, Pogodinskaya str., Moscow, 119121; 8/2, Trubetskaya str., Moscow, 119991



M. V. Ermoshchenkova
Sechenov First Moscow State Medical University (Sechenov University); The First Moscow Clinical Hospital of Oncology of the Moscow Department of Health Care
Russian Federation

Maria V. Ermoshchenkova, Cand. of Sci. (Medicine), Head of the First Oncology Surgery Department

8/2, Trubetskaya str., Moscow, 119991; 17/1, Baumanskaya str., Moscow, 105005

+7 (926) 530-92-84



A. R. Bosieva
P.A. Herzen Moscow Research Institute of Oncology – branch of the FSBI “NMITs radiology” of the Ministry of Health of Russia
Russian Federation

Alana R. Bosieva, postgraduate student, Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin

6, Pogodinskaya str., Moscow, 119121



J. F. Omarova
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Janet F. Omarova, postgraduate student, Department of Oncology, Radiotherapy and Plastic Surgery

8/2, Trubetskaya str., Moscow, 119991



N. N. Volchenko
P.A. Herzen Moscow Research Institute of Oncology – branch of the FSBI “NMITs radiology” of the Ministry of Health of Russia
Russian Federation

Nadezhda N. Volchenko, Dr. of Sci. (Medicine), Professor, Head of Oncomorphology Department

6, Pogodinskaya str., Moscow, 119121



I. V. Reshetov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Igor V. Reshetov, Dr. of Sci. (Medicine), Professor, Academician of the RAS, Director of the Scientific and Educational Clinical Center for Plastic Surgery

8/2, Trubetskaya str., Moscow, 119991

 



References

1. Guidolin R., Lock M., Vogt R., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936

2. Walstra C.J.E.F., Schipper R.J., Poodt I.G.M., et al. Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: A systematic review. Eur J Surg Oncol. 2019; 45(8): 1317–1327. https://doi.org/10.1016/j.ejso.2019.02.008 PMID: 30795956

3. Ozkaya Akagunduz O., Ergen A., Erpolat P., et al. Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study. Breast; 2018; 42: 10–14. https://doi.org/10.1016/j.breast.2018.08.094 PMID: 30121548

4. Dahn H., Wilke D., Walsh G., et al. Radiation and/or endocrine therapy? Recurrence and survival outcomes in women over 70 with early breast cancer after breast-conserving surgery. Breast Cancer Res Treat. 2020; 182(2): 411–420. https://doi.org/10.1007/s10549-020-05691-6 PMID: 32441018

5. Choi J., Laws A., Hu J., et al. Margins in breast-conserving surgery after neoadjuvant therapy. Ann Surg Oncol. 2018 Nov; 25(12): 3541–3547. https://doi.org/10.1245/s10434-018-6702-4 PMID: 30128902

6. Sellam Y., Shahadi I.D., Gelernter I., et al. Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment. Breast J. 2019 Jul; 25(4): 619–624. https://doi.org/10.1111/tbj.13290 PMID: 31087430

7. Valachis A., Mamounas E.P., Mittendorf E.A., et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer. 2018 Jul 15; 124(14): 2923–2930. https://doi.org/10.1002/cncr.31518 PMID: 29723396

8. Cambra M.J., Moreno F., Sanz X., et al. Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients. Clin Transl Oncol. 2020 May; 22(5): 670–680. https://doi.org/10.1007/s12094-019-02168-x PMID: 31264148

9. Fitzal F., Filipits M., Fesl C., et al. PAM-50 predicts local recurrence after breast cancer surgery in postmenopausal patients with ER+/HER2-disease: results from 1204 patients in the randomized ABCSG-8 trial. Br J Surg. 2021 Apr 5; 108(3): 308–314. https://doi.org/10.1093/bjs/znaa089 PMID: 33608712

10. Zumsteg Z.S., Morrow M., Arnold B., et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013 Oct; 20(11): 3469–3476. https://doi.org/10.1245/s10434-013-3011-9 PMID: 23686101

11. Smanykó V., Mészáros N., Újhelyi M., et al. Second breastconserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy. 2019 May-Jun; 18(3): 411–419. https://doi.org/10.1016/j.brachy.2019.02.004 PMID: 30890318

12. Tan P.H., Ellis I., Allison K., et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. 2020 Aug; 77(2): 181–185. https://doi.org/10.1111/his.14091 PMID: 32056259

13. Park S., Ahn S.D., Choi E.K., Kim S.S. The effect of escalating the boost dose for patients with involved resection margin after breast-conserving surgery. Jpn J Clin Oncol. 2018 Mar; 48(3): 272–277. https://doi.org/10.1093/jjco/hyy002 PMID: 29385496

14. Senkus E., Kyriakides S., Ohno S., et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep; 26(5): v8–30. https://doi.org/10.1093/annonc/mdv298 PMID: 26314782

15. Houssami N., Macaskill P., Marinovich M.L., Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014 Mar; 21(3): 717–730. https://doi.org/10.1245/s10434-014-3480-5 PMID: 24473640

16. Amin M.B., Greene F.L., Edge S.B., et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67(2): 93–99. https://doi.org/10.3322/caac.21388 PMID: 28094848

17. Yiannakopoulou E.C., Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol. 2016 May; 42(5): 625–630. https://doi.org/10.1016/j.ejso.2016.02.002 PMID: 26922045

18. De La Cruz L., Blankenship S.A., Chatterjee A., et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol. 2016 Oct; 23(10): 3247–3258. https://doi.org/10.1245/s10434-016-5313-1 PMID: 27357177

19. Guidolin K., Lock M., Vogt K., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019 Dec; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936


Review

Views: 1671


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2218-7332 (Print)
ISSN 2658-3348 (Online)